{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laura M Michon","gend":1,"currentgend":"","add":"63 CRESTVIEW DR","city":"FLORENCE","state":"MA","zip":"01062","dob":"1996-04-17","age":"","mstatus":"","insh":"C0027345400","cliId":"","pno":4135840005,"cno":"","email":"","ename":"","eno":"","pphy":"Alexis T Gorman","ppno":4135842178,"pcpadd":"22 Atwood Dr,Ste 201","pcpcity":"Northampton","pcpstate":"MA","pcpzip":"01060","pcpcounty":"","pcpid":"","pcpname":"CD Practice Associates, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"63 CRESTVIEW DR","madd2":"","madd3":"","mcity":"FLORENCE","mstate":"MA","mzip":"01062","pcpfaxno":"","pcpnpi":1396024246,"currentgendcomment":"","pphycomment":"","uniqueid":132468850,"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":["R99","Z0184","Z0000","F418","E559","Z3041","Z113","Z124","J340","Z6831","J029","J0190","H66001","H109","B9689","R051","J069"],"date":["2025-11-18","2024-03-12","2024-03-12","2024-02-29","2024-02-29","2024-02-29","2024-03-12","2024-02-29","2024-02-29","2024-02-29","2024-11-22","2024-08-11","2024-08-11","2024-08-11","2024-08-11","2024-11-22","2024-11-22"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LESSINA","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUCELVAX QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CLONAZEPAM","","","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":""}]}]}