{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer Pinn","gend":1,"currentgend":"","add":"37 WILKINS RD","city":"BRAINTREE","state":"MA","zip":"02184","dob":"1974-03-27","age":"","mstatus":"","insh":"C0019459300","cliId":"","pno":8572472071,"cno":"","email":"","ename":"","eno":"","pphy":"Nancy Chung","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":"","add3":"","madd1":"37 WILKINS RD","madd2":"","madd3":"","mcity":"BRAINTREE","mstate":"MA","mzip":"02184","pcpfaxno":"","pcpnpi":1689303935,"currentgendcomment":"","pphycomment":"","uniqueid":97195150,"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":["L293","L282","J45909","Z23","L292","R350","E0590","E6601","E559","I10","E538","Z713","Z789","G4733","R99","A6000","R112","R1032","R197","R519","R10817","K449","K429","K5730","F331","F411","Z634","K2900","R1084","R42","Z20822","J029","F32A","Z6843","E041","K469"],"date":["2024-10-21","2024-10-05","2024-10-05","2024-10-05","2024-10-21","2024-10-21","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2025-03-07","2025-03-17","2024-04-24","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2025-03-22","2025-03-22","2025-03-22","2024-04-02","2024-04-02","2024-05-22","2024-05-20","2024-05-22","2024-05-16","2024-07-30","2024-05-16","2024-05-16"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}