{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David M Levesque","gend":0,"currentgend":"","add":"28 Cromesett Rd","city":"wareham","state":"MA","zip":"02571","dob":"1968-01-06","age":"","mstatus":"","insh":"C0022562800","cliId":"","pno":6785573479,"cno":"","email":"","ename":"","eno":"","pphy":"John K Terzian","ppno":5085831100,"pcpadd":"711 W Center St,","pcpcity":"West Bridgewater","pcpstate":"MA","pcpzip":"02379","pcpcounty":"","pcpid":"","pcpname":"Bridgewater Primary Care and Cardiology, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 Cromesett Rd","madd2":"","madd3":"","mcity":"wareham","mstate":"MA","mzip":"02571","pcpfaxno":"","pcpnpi":1619963337,"currentgendcomment":"","pphycomment":"","uniqueid":104065400,"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":["F17200","R062","R7989","R891","I10","R99","E785","R7303","Z6837","Z122","F17210","J432","R9431","R079","R0600","R0989","I459","Z131","Z8249","K5792","E291","I517","I77810","Z139","E559","R9720","Z0000","Z13220","Z716","D122","D124","Z860100","Z09","Z860101","K635","K648","Z1211"],"date":["2025-12-12","2024-02-02","2024-05-05","2025-10-06","2025-12-31","2025-11-17","2025-12-31","2025-12-12","2025-12-12","2025-03-20","2025-03-20","2025-03-20","2025-12-12","2025-12-12","2025-12-12","2025-12-12","2025-12-12","2025-08-01","2024-10-25","2024-10-25","2025-10-06","2025-12-12","2025-12-12","2025-03-01","2025-03-01","2025-05-31","2025-08-01","2025-05-29","2025-12-12","2025-08-08","2025-08-08","2025-08-08","2025-08-08","2025-08-08","2025-08-08","2025-08-08","2025-08-08"],"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":[["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","TESTOSTERONE CYPIONATE","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","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":""}]}]}