{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Heather L Brown","gend":1,"currentgend":"","add":"685 BURT ST","city":"TAUNTON","state":"MA","zip":"02780","dob":"1984-01-18","age":"","mstatus":"","insh":"C0002108800","cliId":"","pno":5088020995,"cno":"","email":"","ename":"","eno":"","pphy":"Priti Patel","ppno":5088800070,"pcpadd":"233 Winthrop St,","pcpcity":"Taunton","pcpstate":"MA","pcpzip":"02780","pcpcounty":"","pcpid":"","pcpname":"Internal Medicine and Preventive Care, PC","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"685 BURT ST","madd2":"","madd3":"","mcity":"TAUNTON","mstate":"MA","mzip":"02780","pcpfaxno":"","pcpnpi":1013986884,"currentgendcomment":"","pphycomment":"","uniqueid":57628200,"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","E559","G43109","F419","R1310","Z760","F418","K219","J329","H6693","R895","B379","J0100","E041","D802","Z1231","R92323","K648","R194","R42","R519","Z79899","E042","Z01419","N930","Z124","E782","R5383","Z0000","K760","J302","D849","K921","R946","R768","R12","Z1211","R051","R059","H9201","H9203","Z01411","Z1239","M7521","R202","M79602","R7689"],"date":["2025-12-14","2025-11-15","2025-12-11","2025-12-11","2024-04-30","2025-12-26","2024-07-22","2025-12-11","2024-09-08","2024-09-08","2024-09-08","2025-12-11","2025-12-11","2025-12-11","2025-04-30","2025-04-10","2024-04-05","2024-06-14","2024-06-18","2024-08-17","2024-08-17","2024-08-17","2025-08-07","2025-02-24","2025-03-24","2025-02-24","2025-12-11","2025-12-11","2025-04-30","2025-12-11","2024-03-22","2024-12-04","2024-04-30","2025-08-08","2025-04-30","2024-06-14","2025-04-30","2024-07-31","2024-07-31","2024-09-16","2024-10-22","2025-02-24","2025-04-30","2025-03-07","2025-12-08","2025-12-08","2025-11-15"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AZITHROMYCIN","","","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":""}]}]}