{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christine E Hagerty","gend":1,"currentgend":"","add":"15 S KINGMAN ST","city":"LAKEVILLE","state":"MA","zip":"02347","dob":"1990-07-20","age":"","mstatus":"","insh":"C0014783100","cliId":"","pno":7747667352,"cno":"","email":"","ename":"","eno":"","pphy":"Remya Tharackal-Ravindran","ppno":5088940400,"pcpadd":"110 Liberty St,Ste 2B","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":"15 S KINGMAN ST","madd2":"","madd3":"","mcity":"LAKEVILLE","mstate":"MA","mzip":"02347","pcpfaxno":"","pcpnpi":1639476690,"currentgendcomment":"","pphycomment":"","uniqueid":87740950,"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":["Z0000","R99","J45909","G4733","J4520","F32A","Z87891","E6601","Z6839","S50362A","Z803","F17210","R5383","A7749","I7300","M7910","Z79899","B6000","M25561","L700","R233","F419","L989","F4310","F418","F900","Z801","Z8249","Z823","Z8349","Z840","Z98890","W57XXXA","Z1331","Z91018","Z91048","Z91010","M546","Z538","R768","Z7951","M47816","M4306","M51379"],"date":["2025-11-09","2025-12-11","2024-09-16","2025-04-18","2024-04-18","2025-11-09","2024-04-18","2024-09-09","2024-09-09","2024-09-09","2024-09-09","2024-09-09","2025-11-09","2024-08-10","2025-04-18","2025-04-18","2025-11-09","2025-04-18","2025-11-09","2025-11-09","2025-11-09","2025-11-09","2025-11-09","2025-12-05","2025-12-05","2025-12-05","2025-04-18","2025-04-18","2024-08-10","2025-11-11","2024-08-10","2025-11-11","2024-09-09","2025-11-09","2024-08-10","2024-08-10","2025-11-11","2025-04-18","2025-04-18","2025-11-09","2025-11-11","2025-11-11","2025-11-11","2025-11-11"],"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":[["","","VENTOLIN HFA","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","BACLOFEN","","","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":""}]}]}