{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Khamsay Chanthanouvong","gend":1,"currentgend":"","add":"33 TAFT ST","city":"SOUTHBRIDGE","state":"MA","zip":"01550","dob":"1962-09-21","age":"","mstatus":"","insh":"C0016836500","cliId":"","pno":5088641762,"cno":"","email":"","ename":"","eno":"","pphy":"Vladas Litani","ppno":5087644885,"pcpadd":"100 South St,Ste 202","pcpcity":"Southbridge","pcpstate":"MA","pcpzip":"01550","pcpcounty":"","pcpid":"","pcpname":"Vladas Litani, MD","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"33 TAFT ST","madd2":"","madd3":"","mcity":"SOUTHBRIDGE","mstate":"MA","mzip":"01550","pcpfaxno":"","pcpnpi":1528072360,"currentgendcomment":"","pphycomment":"","uniqueid":92003900,"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":["D060","E039","E119","I10","Z7984","Z79890","Z79899","L508","L299","R100","R0989","R55","R42","R110","R1110","R109","R112","D259","E8722","I6523","F411","E7841","E559","Z124","R87613","D251","D252","N858","N879","D069","N72","N760","R99","R270"],"date":["2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-04-02","2025-04-02","2024-06-11","2024-06-11","2024-07-11","2024-06-11","2024-06-11","2024-06-11","2024-06-11","2024-07-11","2025-02-25","2024-12-12","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-01-04","2025-05-27","2025-08-04","2025-08-04","2025-05-27","2025-10-06","2025-10-06","2025-10-06","2025-07-28","2025-12-12","2024-07-11"],"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":[["","","CIMETIDINE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","XOLAIR","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","IBUPROFEN","","","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":""}]}]}