{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Frederick W Nordahl","gend":0,"currentgend":"","add":"119 BELCHER ST","city":"HOLBROOK","state":"MA","zip":"02343","dob":"1968-06-25","age":"","mstatus":"","insh":"C0021273300","cliId":"","pno":8572379385,"cno":"","email":"","ename":"","eno":"","pphy":"Luei Ong","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":"119 BELCHER ST","madd2":"","madd3":"","mcity":"HOLBROOK","mstate":"MA","mzip":"02343","pcpfaxno":"","pcpnpi":1841670536,"currentgendcomment":"","pphycomment":"","uniqueid":100688350,"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":["N022","R99","M5430","I10","N0620","R350","Z9225","Z87891","Z973","Z9109","Z96659","Z8249","N184","Z1211","D122","K5730","K641","K649","K635","N032","N189","R7989","N1830","R600","Z91018","Z98890","R0789","R079","Z9989","E871","Z0000","M75102","M5432","E6601","N400","M1731","Z96651","H5789","Z6842","M25572","M25472","M79672","G4700","K5790","M19072","M7989","M7732","Q798","Z91048","M7662","Z7902","H16223","H02883","H02886","H02823","H11442","N401","J301","I83893","N138","R059","H0288A","H0288B","H5203","H52223","M21611","M722","M109","Z7952","R2241","M79661","M25561","M25562","D179","E785","G4733","R062","Z79899","Z0001","Z1389","L821","L918","H01009","M5450","G8929","M7582","M12812","N0629","I129","Z9229","N0421","R808","E6609","Z6843","M1712","M542","G629","H01003","M62512"],"date":["2025-11-17","2025-12-23","2025-12-03","2025-11-02","2025-11-02","2025-11-02","2025-11-02","2025-11-02","2025-11-02","2025-09-23","2025-09-23","2025-09-23","2025-11-17","2024-09-02","2024-09-02","2024-09-02","2024-09-02","2024-09-02","2024-09-02","2024-07-27","2024-11-05","2025-01-02","2024-11-05","2024-03-22","2025-11-02","2025-05-20","2025-06-26","2025-06-26","2024-01-04","2024-04-27","2025-05-07","2025-09-23","2024-06-25","2025-06-26","2024-06-25","2024-06-25","2025-11-02","2024-06-25","2025-06-26","2024-07-25","2024-07-25","2024-09-12","2025-06-26","2024-09-02","2024-07-25","2024-12-20","2024-07-25","2024-07-25","2024-09-12","2024-08-29","2024-08-29","2025-09-04","2024-03-10","2024-03-10","2025-09-04","2024-03-10","2025-06-26","2024-10-29","2024-10-29","2024-12-23","2024-11-27","2025-09-04","2025-09-04","2024-05-12","2024-05-12","2024-09-12","2025-06-26","2025-06-26","2024-12-20","2024-12-20","2024-12-20","2025-06-26","2025-06-26","2024-12-23","2025-06-26","2025-07-01","2024-11-27","2025-06-14","2025-06-26","2025-06-26","2025-07-25","2025-07-25","2025-07-25","2025-07-25","2025-07-25","2025-08-20","2025-09-23","2024-03-22","2024-01-04","2024-01-04","2024-12-17","2024-01-04","2024-04-30","2024-04-30","2024-07-25","2025-06-26","2025-06-26","2025-07-25","2025-09-23"],"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":[["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","FLUZONE TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","CYCLOSPORINE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TACROLIMUS","","","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":""}]}]}