{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mariah L Harper","gend":1,"currentgend":"","add":"554 Bark St","city":"Swansea","state":"MA","zip":"02777","dob":"1996-06-27","age":"","mstatus":"","insh":"C0022287100","cliId":"","pno":7743659848,"cno":"","email":"","ename":"","eno":"","pphy":"Daniel R Simoneau","ppno":5086798111,"pcpadd":"387 Quarry St,Ste 100","pcpcity":"Fall River","pcpstate":"MA","pcpzip":"02723","pcpcounty":"","pcpid":"","pcpname":"HealthFirst Family Care Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"554 Bark St","madd2":"","madd3":"","mcity":"Swansea","mstate":"MA","mzip":"02777","pcpfaxno":"","pcpnpi":1023421880,"currentgendcomment":"","pphycomment":"","uniqueid":103468950,"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":["N898","N920","R1020","Z113","R350","N3281","R3915","R059","F329","R99","G4711","F411","R42","R051","Z139","Z111","F5089","F321","F909","J029","N390","R300","J0190","R0602","Z713","Z7182","Z3202","Z3042","Q860","Z79899","Z1331","Z3009","R0982","R41840","L723","Z30430","G4712","Z01419"],"date":["2025-10-10","2025-10-10","2025-12-10","2025-12-19","2026-01-05","2026-01-07","2026-01-05","2025-07-28","2026-02-13","2026-02-13","2026-01-14","2026-02-13","2024-10-14","2024-10-14","2024-10-14","2024-09-27","2025-03-13","2025-11-21","2025-08-29","2025-07-15","2024-09-21","2024-10-04","2024-10-04","2024-10-14","2024-10-14","2024-10-14","2025-02-11","2024-11-06","2024-12-04","2024-12-04","2024-12-04","2025-01-28","2025-02-08","2025-02-08","2025-02-08","2025-02-11","2025-04-09","2025-08-20"],"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",""],["","","PREDNISONE","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ARMODAFINIL","","","Select","Select",""],["","","BUSPIRONE HCL","","","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":""}]}]}