{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anne K Reed","gend":1,"currentgend":"","add":"651 RICHARD A FITTS DR","city":"ABINGTON","state":"MA","zip":"02351","dob":"1984-06-12","age":"","mstatus":"","insh":"C0018327200","cliId":"","pno":7819566334,"cno":"","email":"","ename":"","eno":"","pphy":"Daniel Feleke","ppno":5088940400,"pcpadd":"110 Liberty St,","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"651 RICHARD A FITTS DR","madd2":"","madd3":"","mcity":"ABINGTON","mstate":"MA","mzip":"02351","pcpfaxno":"","pcpnpi":1598905630,"currentgendcomment":"","pphycomment":"","uniqueid":94786200,"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":["M5412","Z1231","M7918","Z0000","Z124","Z23","Z1331","Z87891","F418","Z981","M50122","Z01818","Z4789","F4310","F331","F411","F410","F1021","F1020","F900","R200","Z8669","M50222","M50223","I6529","M542","D61818","D801","Z98891","M5013","M9961","Z029","Z98890","M50022","M50023","Z01419","Z20822","J029","K1379","M50123","M48062","J0100","M50322","M50323","F419","F32A","R300","R99","K0889","J0190","M4802","D649","Z79899","M5020"],"date":["2024-11-25","2024-12-04","2024-04-15","2024-06-14","2024-06-14","2024-06-14","2024-06-14","2025-01-29","2024-06-14","2024-11-25","2024-12-02","2024-03-05","2024-05-20","2025-12-18","2025-04-04","2025-04-04","2025-04-04","2025-04-04","2025-03-14","2024-02-05","2024-12-02","2024-12-02","2024-12-02","2024-12-02","2024-12-02","2024-12-02","2024-12-02","2024-03-19","2024-02-22","2024-02-26","2024-02-26","2024-03-19","2024-09-05","2024-09-05","2024-09-05","2024-06-14","2024-09-17","2024-12-10","2024-09-17","2024-09-05","2024-08-14","2025-01-20","2024-03-25","2024-03-25","2025-01-29","2025-01-29","2025-06-12","2025-08-14","2024-09-17","2025-01-20","2024-12-02","2024-12-02","2024-12-02","2024-02-26"],"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":[["","","BUPROPION XL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","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":""}]}]}