{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Billie Jo Howe","gend":1,"currentgend":"","add":"16 WAUKEWAN ST","city":"MEREDITH","state":"NH","zip":"03253","dob":"1967-07-25","age":"","mstatus":"","insh":"61037854100","cliId":"","pno":"6037072965","cno":"","email":"","ename":"","eno":"","pphy":"Mary-Claire S Paicopolis","ppno":"6035288555","pcpadd":"369 Hounsell Ave, Ste 5","pcpcity":"Gilford","pcpstate":"NH","pcpzip":"03249","pcpcounty":"","pcpid":"","pcpname":"Laconia Cardiology PA","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - NH - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 591","madd2":"","madd3":"","mcity":"MEREDITH","mstate":"NH","mzip":"03253","pcpfaxno":"","pcpnpi":"1114018322","currentgendcomment":"","pphycomment":"","uniqueid":"153326200","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","Z780","M8580","Z79899","M549","D329","Z1329","E7439","I10","I495","R5383","R0602","I4720","E782","R55","I723","M8589","D1771","Z041","I7300","R519","R410","Z8673","I493","D6800","M5450","M47816","M47814","D499","Z4509","Z95810","Z01810","R000","R079","I2510"],"date":["2026-02-09","2025-07-03","2026-01-12","2025-07-03","2025-11-19","2025-12-08","2025-12-15","2025-12-15","2025-12-19","2025-12-19","2025-12-15","2026-01-23","2025-12-07","2025-11-13","2025-06-05","2025-11-13","2025-07-03","2025-08-01","2025-09-09","2026-01-12","2025-10-14","2025-10-14","2025-10-14","2025-11-21","2025-11-21","2025-11-19","2025-11-19","2025-11-19","2025-12-08","2025-12-19","2025-12-19","2025-12-19","2025-12-19","2025-12-19","2025-12-19"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","NITRO-BID","","","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":""}]}]}