{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sokhom Sor","gend":0,"currentgend":"","add":"139 COTTAGE ST","city":"LYNN","state":"MA","zip":"01905","dob":"1967-05-12","age":"","mstatus":"","insh":"C0015679500","cliId":"","pno":7816323295,"cno":"","email":"","ename":"","eno":"","pphy":"Nida Lam","ppno":7817807755,"pcpadd":"280 Union St,Ste 402","pcpcity":"Lynn","pcpstate":"MA","pcpzip":"01901","pcpcounty":"","pcpid":"","pcpname":"Byron Medical Group, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"139 COTTAGE ST","madd2":"","madd3":"","mcity":"LYNN","mstate":"MA","mzip":"01905","pcpfaxno":"","pcpnpi":1780998765,"currentgendcomment":"","pphycomment":"","uniqueid":89321400,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K449","K5901","K7689","N281","N289","I10","E782","M25522","R718","R7303","D563","L4050","M7552","L400","L408","L219","L700","L4052","M5432","Z5181","Z79631","Z0001","Z23","Z1211","K219","M25562","G8929","Z7184","K760","M069","H11001","H2513","H33311","K5900","R140","M6740","Z7185","D84821","Z79899","L309","T148XXA","M79675","R99","L739","R918","N2889","H47393","Z111","Z2839","T887XXA"],"date":["2024-05-06","2024-05-06","2024-06-24","2024-07-18","2024-07-24","2025-08-19","2025-09-09","2025-01-08","2024-09-09","2025-09-09","2025-08-19","2025-09-23","2025-02-12","2025-09-23","2025-05-20","2025-02-12","2024-10-24","2025-05-20","2025-05-20","2025-05-20","2025-05-20","2025-01-29","2025-02-09","2025-12-08","2025-01-29","2025-01-29","2025-01-29","2025-03-21","2025-10-05","2025-03-19","2025-05-15","2025-05-15","2025-05-15","2025-12-08","2025-12-08","2025-02-09","2025-02-09","2025-02-12","2025-02-09","2025-09-10","2025-09-10","2025-10-20","2025-12-29","2024-03-26","2024-04-23","2024-07-18","2024-02-29","2024-11-03","2024-11-03","2024-03-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","TACROLIMUS","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","ZORYVE","","","Select","Select",""],["","","FOLIC ACID","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TYPHIM VI","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","HUMIRA PEN","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}