{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth A Davis","gend":1,"currentgend":"","add":"425 Salem St","city":"Rockland","state":"MA","zip":"02370","dob":"1984-06-10","age":"","mstatus":"","insh":"C0014474000","cliId":"","pno":5083833079,"cno":"","email":"","ename":"","eno":"","pphy":"Syed Imam","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":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"425 Salem St","madd2":"","madd3":"","mcity":"Rockland","mstate":"MA","mzip":"02370","pcpfaxno":"","pcpnpi":1972789592,"currentgendcomment":"","pphycomment":"","uniqueid":86998050,"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":["K8070","R112","R197","J45909","Z880","K8010","K660","R5383","G43909","R0602","R0789","R42","R110","Z3202","R079","A084","R202","L03311","L02211","L02416","A6920","H9191","H9311","R29818","H538","L089","Z1231","L0390","L03115","Z0000","L02435","Z1331","K8050","Z98891","Z9851","L231","K8020","R99","Z791","F419","Z79899","L03317","T148XXA","L0291","R590","L0889","D649","Z8614"],"date":["2025-11-28","2025-11-28","2025-11-28","2025-11-28","2025-11-28","2025-12-03","2025-12-03","2024-12-05","2025-01-03","2025-10-08","2024-12-05","2025-01-03","2025-01-03","2025-01-03","2025-10-08","2025-01-08","2025-01-08","2025-12-23","2025-03-19","2025-05-28","2025-06-01","2025-08-14","2025-08-14","2025-07-22","2025-07-22","2025-07-21","2025-07-24","2025-10-08","2025-10-08","2025-10-16","2025-10-16","2025-10-16","2025-12-01","2025-12-01","2025-12-01","2025-12-11","2025-12-03","2025-12-23","2024-12-05","2025-10-08","2025-03-19","2025-05-28","2025-06-01","2025-06-01","2025-06-01","2025-07-22","2025-10-08","2025-10-08"],"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":[["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}