{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kelsey Hannon","gend":1,"currentgend":"","add":"20 COTUIT RD","city":"BOURNE","state":"MA","zip":"02532","dob":"1991-02-28","age":"","mstatus":"","insh":"C0027851600","cliId":"","pno":7746789040,"cno":"","email":"","ename":"","eno":"","pphy":"Nazanin J Ronan","ppno":5084777090,"pcpadd":"107 Commercial St,","pcpcity":"Mashpee","pcpstate":"MA","pcpzip":"02649","pcpcounty":"","pcpid":"","pcpname":"Community Health Center of Cape Cod","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 COTUIT RD","madd2":"","madd3":"","mcity":"BOURNE","mstate":"MA","mzip":"02532","pcpfaxno":"","pcpnpi":1720076466,"currentgendcomment":"","pphycomment":"","uniqueid":134401900,"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":["R99","F332","F1290","F411","F4310","Z87891","Z79899","F419","Z1152","F331","F3132","F12188","R112","J9601","M5441","K529","D72829","G8929","F3130","F410","F319","R1110","R748","M5137","I499","I160","N946","Z139","E663","K30","R1013","R61","M9901","M9902","I4510","R9431","Z01419","R4586","Z124","R001","M9903","R002","R0602","F29","F32A","I361","I10","F339","R45851","R7881","Q279","L813","H539","Z6827","W891XXA","D225","D485","L814","L812","F322","Z0001","Z0100","H52221"],"date":["2025-12-19","2024-12-11","2024-11-18","2025-11-04","2025-11-04","2024-12-11","2025-06-06","2024-12-11","2024-12-11","2025-11-04","2024-06-26","2024-04-21","2024-12-16","2024-04-21","2025-03-17","2024-04-21","2024-04-21","2024-04-21","2024-04-21","2025-12-09","2025-12-09","2024-04-20","2024-04-20","2024-04-20","2024-07-15","2024-04-20","2024-08-20","2024-05-28","2025-03-17","2024-11-06","2024-11-06","2024-07-06","2025-09-17","2025-09-17","2024-07-15","2024-11-14","2024-08-20","2024-08-20","2024-08-20","2024-09-20","2025-09-17","2024-10-11","2024-10-11","2024-12-11","2024-10-11","2024-11-15","2024-11-18","2024-12-11","2024-12-11","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-01-14","2025-01-14","2025-01-14","2025-01-14","2025-01-14","2025-03-17","2025-06-06","2025-07-18","2025-07-18"],"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",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","BUPROPION HCL SR","","","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":""}]}]}