{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ushaben S Prajapati","gend":1,"currentgend":"","add":"1 ASPINET RD","city":"S YARMOUTH","state":"MA","zip":"02664","dob":"1986-09-18","age":"","mstatus":"","insh":"C0009311201","cliId":"","pno":6175057023,"cno":"","email":"","ename":"","eno":"","pphy":"Vimal Patel","ppno":5084774282,"pcpadd":"5 Industrial Dr,Ste 100","pcpcity":"Mashpee","pcpstate":"MA","pcpzip":"02649","pcpcounty":"","pcpid":"","pcpname":"Hyannis Family Medical Care PC","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 ASPINET RD","madd2":"","madd3":"","mcity":"S YARMOUTH","mstate":"MA","mzip":"02664","pcpfaxno":"","pcpnpi":1427198787,"currentgendcomment":"","pphycomment":"","uniqueid":68731051,"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","R0789","H1033","K219","U071","J069","L500","J0390","R110","R059","Z79899","J3501","E119","Z7984","R079","E1165","L259","H5789","H109","Z0000","Z13220","Z1211","Z1389","H5213","H52223","J309","J310","R519","R220","R42","H53139","R2681","J029","R509","H6090","R599","J40","R062"],"date":["2025-10-13","2024-04-24","2024-07-26","2025-09-22","2025-02-23","2025-09-22","2025-08-14","2025-09-22","2025-09-18","2025-09-18","2025-09-22","2025-09-24","2025-09-12","2025-09-12","2024-04-24","2024-10-10","2024-11-06","2024-12-08","2024-09-30","2024-10-10","2025-06-12","2024-10-10","2025-06-12","2025-04-11","2025-04-11","2024-11-15","2024-11-15","2025-06-26","2025-05-16","2025-05-16","2025-05-16","2025-05-16","2025-09-24","2025-09-15","2025-09-15","2025-09-15","2025-09-24","2025-09-24"],"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":[["","","GLYBURIDE-METFORMIN HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLULAVAL TRIVALENT 2024-2025","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","OXYCODONE HCL","","","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":""}]}]}