{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Darlene M Mclaughlin","gend":1,"currentgend":"","add":"82 TAUNTON ST","city":"LAKEVILLE","state":"MA","zip":"02347","dob":"1961-10-19","age":"","mstatus":"","insh":"C0022416500","cliId":"","pno":7742260571,"cno":"","email":"","ename":"","eno":"","pphy":"Kerry Girard","ppno":5086973677,"pcpadd":"545 Bedford St,","pcpcity":"Bridgewater","pcpstate":"MA","pcpzip":"02324","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"82 TAUNTON ST","madd2":"","madd3":"","mcity":"LAKEVILLE","mstate":"MA","mzip":"02347","pcpfaxno":"","pcpnpi":1871541045,"currentgendcomment":"","pphycomment":"","uniqueid":103800050,"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":["Z96642","M1612","M25652","R531","Z1231","F329","E88819","Z79899","Z9089","Z818","Z87891","G4700","Z6827","E663","F909","Z833","Z9049","Z800","Z981","R99","M5136","Z967","M4316","Z4789","M48062","M5416","F32A","E785","Z4889","M4327","M5450","Z01818","R7303","E7800","R7309","E669","Z6830","Z471","Z96641","G629","F900","E559","H524","Z7982","Z8616","Z0000","Z124","Z1151","Z8742","M4326","R5383","Z98890","Z6831","M160","M25552","Z820","M47817","R030","M51369","M898X5","M51379","M2578","E66811","J45909"],"date":["2025-06-04","2025-06-04","2025-06-04","2025-06-04","2025-05-15","2025-06-11","2025-11-26","2025-08-27","2025-11-26","2025-06-11","2025-11-26","2025-08-27","2025-08-27","2025-08-27","2025-11-26","2025-11-26","2025-11-26","2025-11-26","2025-02-14","2026-02-26","2024-07-24","2024-04-04","2025-02-14","2024-06-11","2024-07-24","2025-04-10","2024-04-11","2025-03-10","2025-03-21","2024-11-06","2025-02-14","2025-03-07","2025-04-10","2025-04-10","2025-02-21","2025-03-10","2025-03-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-30","2025-04-30","2025-04-30","2025-04-30","2024-06-11","2024-04-23","2025-05-02","2025-04-30","2025-02-14","2024-06-14","2025-05-02","2024-11-06","2024-10-30","2024-11-06","2025-02-14","2025-02-14","2025-02-14","2025-04-30","2025-03-10"],"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":[["","","METHOCARBAMOL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ADDERALL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ASPIRIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}