{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rachel S Piscette","gend":1,"currentgend":"","add":"469 AUDUBON RD","city":"LEEDS","state":"MA","zip":"01053","dob":"1989-09-25","age":"","mstatus":"","insh":"C0033552800","cliId":"","pno":4346652895,"cno":"","email":"","ename":"","eno":"","pphy":"Steven Esrick","ppno":4135868400,"pcpadd":"70 Main St,","pcpcity":"Florence","pcpstate":"MA","pcpzip":"01062","pcpcounty":"","pcpid":"","pcpname":"Valley Medical Group, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"469 AUDUBON RD","madd2":"","madd3":"","mcity":"LEEDS","mstate":"MA","mzip":"01053","pcpfaxno":"","pcpnpi":1154321875,"currentgendcomment":"","pphycomment":"","uniqueid":145472300,"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","F419","Z0000","M9901","M9902","M9903","M7912","M7918","G542","J029","R002","S29012A","H6503","H60502","H906","F32A","H608X3","E282","N951","N940"],"date":["2026-01-30","2026-01-23","2025-02-24","2025-06-18","2025-06-18","2025-06-18","2025-06-18","2025-06-18","2025-06-18","2025-01-07","2025-01-29","2025-04-03","2025-10-20","2025-10-20","2025-02-26","2025-02-26","2025-10-30","2025-11-11","2025-11-11","2025-11-11"],"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":[["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","HYDROCORTISONE-ACETIC ACID","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","VENTOLIN HFA","","","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":""}]}]}