{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathleen M Arndt","gend":1,"currentgend":"","add":"291 Central St","city":"Mansfield","state":"MA","zip":"02048","dob":"1964-04-03","age":"","mstatus":"","insh":"C0010099800","cliId":"","pno":7742634990,"cno":"","email":"","ename":"","eno":"","pphy":"Dino C Constantinou","ppno":5088940400,"pcpadd":"110 Liberty St,","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","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":"291 Central St","madd2":"","madd3":"","mcity":"Mansfield","mstate":"MA","mzip":"02048","pcpfaxno":"","pcpnpi":1770578932,"currentgendcomment":"","pphycomment":"","uniqueid":69550400,"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","M5417","M5412","Z0000","E663","R7401","R7309","R5383","Z780","G4700","Z1211","M5416","K219","R1314","K589","K760","M25512","M25411","M542","R1310","M7551","M25511","M48061","S71131A","S71151A","D649","E785","M1990","M719","L292","R350","N8111","R351","Z01419","N3000","N393","N343","N368","R3912","R39198","M170","R002","L918","R197","K2289","R079","R519","R109","Z9049","M79622","R609","L539","L03114","E8342","E876","R531","I10","L0390","I890","J45909","Z853","Z9010","E039","E1165","E119","E8339","K529","K8050","M7541","M75111","M25811","F419","F4310","W540XXA","Z1331","M19011","Z9013","Z6827","Z87891","Z6831","Z0100","G8918","R7989","R7303","Z6826","N760","N390","N39498","N9410","N952","N958","U071","J0100","F418","K317","F32A","Z791","Z7951","Z79890","Z79899","C50919","Z7985","Z6828","Z01812","F4311","F4312","R739","M5450"],"date":["2025-12-17","2024-02-22","2024-02-22","2025-10-03","2025-10-03","2024-02-27","2024-06-28","2025-05-27","2024-02-27","2025-02-18","2025-10-03","2024-09-04","2024-12-17","2024-12-17","2025-02-09","2025-05-27","2024-08-27","2024-04-24","2024-08-27","2024-04-17","2025-03-26","2025-10-04","2024-06-16","2024-07-16","2024-07-16","2024-06-28","2025-10-03","2024-06-28","2024-06-28","2024-07-24","2025-02-09","2024-07-24","2024-07-24","2025-02-09","2025-08-12","2024-07-24","2024-07-24","2024-07-24","2024-07-24","2024-07-24","2024-05-31","2024-08-20","2024-08-20","2024-12-17","2024-04-18","2024-01-10","2024-01-10","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2025-06-10","2024-10-24","2024-10-24","2024-10-22","2025-10-03","2025-09-04","2025-09-04","2024-07-11","2025-05-27","2024-07-11","2024-10-24","2024-10-24","2025-10-03","2024-10-24","2024-10-24","2024-10-24","2025-10-04","2024-11-20","2024-11-27","2024-12-31","2025-02-18","2024-11-22","2024-11-22","2025-09-04","2025-02-18","2025-10-03","2025-10-03","2025-10-03","2025-03-19","2025-03-26","2025-05-27","2025-08-25","2025-05-27","2025-02-09","2025-05-27","2025-02-09","2025-02-09","2025-02-09","2025-08-12","2025-06-10","2025-08-12","2024-08-29","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2025-09-04","2025-05-27","2025-09-04","2024-12-31","2025-03-24","2025-07-01","2025-11-11","2024-02-26","2024-02-22"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ESTRING","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","CHOLESTYRAMINE LIGHT","","","Select","Select",""],["","","PHENTERMINE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CIPROFLOXACIN 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":""}]}]}