{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer L Lewis","gend":1,"currentgend":"","add":"28 CHURCHILL RD","city":"LAKEVILLE","state":"MA","zip":"02347","dob":"1970-06-06","age":"","mstatus":"","insh":"C0002880500","cliId":"","pno":7815359621,"cno":"","email":"","ename":"","eno":"","pphy":"Divjot K Sooch","ppno":5088940400,"pcpadd":"1215 Broadway,","pcpcity":"Raynham","pcpstate":"MA","pcpzip":"02767","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 CHURCHILL RD","madd2":"","madd3":"","mcity":"LAKEVILLE","mstate":"MA","mzip":"02347","pcpfaxno":"","pcpnpi":1275731853,"currentgendcomment":"","pphycomment":"","uniqueid":59311800,"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":["Z5111","C50912","Z170","Z7689","Z87891","Z5181","R4781","R9089","R29898","E669","Z6834","C50412","Z9221","G629","R531","I2510","E7800","I10","Z0101","E119","H0102A","H0102B","H01006","H01003","H04123","H524","F17200","M5450","R2991","G6289","R059","R0602","R99","F418","C50919","G250","Z780","M810","Z79811","Z13820","R92333","R222","G5793","Z7984","Z973","Z95828","Z888","Z833","D3502","R160","E278","K869","D259","N83209","R479","R202","Z1721","Z1731","Z801","Z01419","N83202","Z8544","Z0000","R252","J309","E1169","E66811","Z6833","Z1331","Z7985","R9389","R200","Z853","I252","Z8249","Z98890","L659","R229","Z7902","D472","E213","R82994","Z98891","G5603","Z95818","Z8271","Z6835","R220","Z9012","D1721","E785","M79641","M79672","Z79899","R928","D1803","E279","N281","Z1231","R921","N6325","R9431","R001","Z955","C50812","I739","F32A","Z483","M5136","D72829","E1151","I70209","T451X5A","M6281"],"date":["2025-11-04","2025-12-26","2025-12-11","2025-11-04","2025-12-11","2025-09-04","2025-02-05","2024-11-09","2024-11-09","2025-11-26","2025-11-26","2024-12-16","2025-09-10","2025-09-09","2024-09-17","2025-09-10","2025-07-14","2025-09-26","2024-09-24","2025-11-19","2024-09-24","2024-09-24","2024-09-24","2024-09-24","2024-09-24","2024-09-24","2024-09-24","2024-11-19","2024-11-19","2024-11-13","2024-02-22","2024-02-22","2025-12-26","2024-12-06","2024-09-29","2025-12-28","2025-05-04","2025-09-29","2025-12-11","2025-05-04","2025-04-04","2025-09-04","2025-09-04","2025-11-26","2025-09-26","2025-09-04","2025-09-04","2025-12-11","2025-04-15","2025-04-24","2025-11-19","2025-04-28","2025-07-16","2025-04-28","2025-04-24","2025-02-05","2025-12-11","2025-12-11","2025-12-11","2025-06-16","2025-06-16","2025-09-26","2025-06-20","2025-06-20","2025-06-20","2025-11-26","2025-06-20","2025-06-20","2025-06-20","2025-06-20","2025-07-16","2025-09-09","2025-11-18","2025-11-18","2025-12-11","2025-12-11","2025-09-26","2025-09-26","2025-11-18","2025-09-29","2025-09-10","2025-09-10","2025-09-10","2025-04-11","2025-12-11","2025-12-11","2025-11-19","2025-11-18","2025-11-18","2025-10-12","2024-12-16","2024-12-16","2024-12-16","2024-12-16","2025-04-04","2025-04-24","2025-04-24","2025-04-24","2024-03-22","2024-02-04","2024-02-04","2024-03-26","2024-03-26","2024-08-14","2024-08-05","2024-12-06","2024-12-06","2024-05-06","2024-08-19","2024-08-14","2024-08-14","2024-08-14","2024-08-14","2024-08-14"],"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":[["","","BENZONATATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","PRIMIDONE","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","MOUNJARO","","","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":""}]}]}