{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise Loring","gend":1,"currentgend":"","add":"177 BELMONT ST","city":"BELMONT","state":"MA","zip":"02478","dob":"1989-09-13","age":"","mstatus":"","insh":"C0016774400","cliId":"","pno":7815351816,"cno":"","email":"","ename":"","eno":"","pphy":"Sarah Raphaelson","ppno":6173763000,"pcpadd":"110 W Squantum St,","pcpcity":"North Quincy","pcpstate":"MA","pcpzip":"02171","pcpcounty":"","pcpid":"","pcpname":"Manet Community Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"177 BELMONT ST","madd2":"APT 2","madd3":"","mcity":"BELMONT","mstate":"MA","mzip":"02478","pcpfaxno":"","pcpnpi":1609503622,"currentgendcomment":"","pphycomment":"","uniqueid":91617100,"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":["F4323","K219","Z0001","F418","E663","Z6829","R059","Z1339","R1013","E0590","M25531","E0500","M65241","M79641","R609","R079","Z124","Z0000","K2970","G4700","M62838","M9903","M5117","M62830","M9905","M9902","M4004","M9901","M5431","R350","N907","Z77120","M25532","R99","E079","M7989"],"date":["2026-02-03","2024-04-03","2024-06-05","2024-10-10","2024-06-05","2024-06-05","2024-06-05","2024-06-05","2024-06-21","2025-09-22","2024-07-30","2026-02-06","2024-08-28","2024-07-30","2024-07-30","2024-06-17","2024-10-10","2024-10-10","2024-10-10","2024-11-25","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2024-11-25","2025-09-22","2025-08-15","2025-08-15","2024-07-30","2026-02-09","2024-06-17","2024-07-30"],"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":[["","","SERTRALINE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","METHIMAZOLE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}