{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thuong Tran","gend":0,"currentgend":"","add":"425 LINCOLN ST","city":"STOUGHTON","state":"MA","zip":"02072","dob":"1990-10-17","age":"","mstatus":"","insh":"C0012332100","cliId":"","pno":6175169254,"cno":"","email":"","ename":"","eno":"","pphy":"Tara Bylsma","ppno":6172883230,"pcpadd":"1353 Dorchester Ave,","pcpcity":"Dorchester","pcpstate":"MA","pcpzip":"02122","pcpcounty":"","pcpid":"","pcpname":"DotHouse Health Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"425 LINCOLN ST","madd2":"","madd3":"","mcity":"STOUGHTON","mstate":"MA","mzip":"02072","pcpfaxno":"","pcpnpi":1770088502,"currentgendcomment":"","pphycomment":"","uniqueid":79229100,"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":["D869","H44113","E119","D7210","R030","Z599","D860","E559","R7989","R99","H538","H30133","Z114","D8683","R9431","J150","J154","J151","D8689","E781","Z87891","K219","R1310","T884XXA","Z79899","Z23","H40052","Z7984","K760","Z0000","R634","Z113","Z131","Z13220","Z0184","H3023","J189","J9600","R590","J9809","J984","Z09","J988","R846","B999","R918"],"date":["2025-02-28","2025-10-30","2025-12-16","2025-02-24","2025-07-29","2025-07-29","2025-11-21","2025-08-25","2025-08-12","2025-12-26","2024-07-22","2024-07-22","2024-07-29","2024-11-25","2024-08-26","2024-06-09","2024-06-09","2024-06-09","2024-06-09","2024-06-09","2025-11-21","2024-06-09","2024-06-09","2024-06-09","2025-08-01","2024-10-28","2025-10-30","2025-11-21","2025-08-12","2024-03-26","2024-03-27","2024-03-27","2024-03-27","2024-03-27","2024-03-27","2024-07-18","2024-11-09","2024-06-09","2024-06-09","2024-10-09","2024-09-09","2024-11-09","2024-08-09","2024-10-09","2024-09-23","2024-06-09"],"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":[["","","JARDIANCE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","SINGLE USE SWAB","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","DIFLUPREDNATE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","ATROPINE SULFATE","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","FOLIC ACID","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","TREXALL","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","IVERMECTIN","","","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":""}]}]}