{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Priscilla Soares","gend":1,"currentgend":"","add":"3 3RD ST","city":"SWANSEA","state":"MA","zip":"02777","dob":"1964-03-09","age":"","mstatus":"","insh":"C0024853600","cliId":"","pno":5085671901,"cno":"","email":"","ename":"","eno":"","pphy":"Marivyl Laxer","ppno":5086365101,"pcpadd":"827 American Legion Hwy,","pcpcity":"Westport","pcpstate":"MA","pcpzip":"02790","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 3RD ST","madd2":"","madd3":"","mcity":"SWANSEA","mstate":"MA","mzip":"02777","pcpfaxno":"","pcpnpi":1225093362,"currentgendcomment":"","pphycomment":"","uniqueid":107932850,"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":["I10","R99","B029","B0229","J4520","F418","R110","Z0000","R1011","R42","R079","R011","Z1211","K5730","Z87891","Z7982","Z8616","Z1231","Z5181","M818","Z1159","E8352","R319","R2681","E7800","E66811","E6609","Z6830","D75839","H348312","H40013","H25813","H43813","H2513","H5310","R1013","E663","Z6829","Z713","Z7182","R1031","K5900","K449","Z809","Z23","H6592","M25551","Z01419","Z13820","R002","I6523","H35372","H35432","H524","H5789","R200","F32A","R519","H348310","K769","K5790","R935"],"date":["2025-10-30","2025-11-07","2024-06-22","2024-11-07","2025-11-05","2024-10-28","2025-11-19","2025-10-30","2025-11-19","2025-10-30","2024-11-06","2024-11-06","2025-02-12","2024-10-28","2025-10-30","2024-01-08","2024-01-08","2025-09-10","2024-10-28","2025-10-30","2024-10-28","2024-11-18","2024-11-22","2025-06-24","2025-10-30","2025-10-30","2025-04-15","2025-04-15","2025-11-26","2025-11-04","2025-11-04","2024-02-14","2025-11-04","2025-11-26","2024-04-25","2024-04-29","2025-10-30","2025-10-30","2025-04-15","2025-04-15","2024-06-20","2024-10-28","2024-07-22","2024-01-08","2024-10-28","2024-11-22","2024-11-22","2025-02-12","2025-02-12","2024-12-12","2024-12-13","2025-11-26","2025-11-04","2025-11-04","2025-05-23","2025-06-16","2025-06-16","2025-06-24","2025-11-26","2025-08-12","2025-08-12","2025-08-12"],"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":[["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","PREVNAR 20","","","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":""}]}]}