{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wanda j Sisum","gend":1,"currentgend":"","add":"280B rte 130 ste1","city":"forestdale","state":"MA","zip":"02644","dob":"1961-05-02","age":"","mstatus":"","insh":"C0027586600","cliId":"","pno":5083641330,"cno":"","email":"","ename":"","eno":"","pphy":"Barbara Robinson","ppno":7745523201,"pcpadd":"770 Main St,","pcpcity":"Osterville","pcpstate":"MA","pcpzip":"02655","pcpcounty":"","pcpid":"","pcpname":"Medical Affiliates of Cape Cod, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"280B rte 130 ste1","madd2":"","madd3":"","mcity":"forestdale","mstate":"MA","mzip":"02644","pcpfaxno":"","pcpnpi":1003953415,"currentgendcomment":"","pphycomment":"","uniqueid":133520300,"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","N760","J069","R053","Z1231","M25562","M79662","M7989","Z13820","Z0001","E8940","M797","N6322","N6320","Z872","I10","E039","R29898","R5383","K645","R051","H2513","H348322","H43812","H35363","M1712","M2550","M357","G43009","M542","M5481","Z01419","Z8742","N949","R42","N6002","Z98890","G4486","J45909","E7800","G479","L659","M19041","M7051","M19042","R0689","L814","L821","D2322","D2321","L739","Z7189","R002","R509","R000","G8929","M2392"],"date":["2025-12-18","2024-10-18","2025-10-22","2026-01-17","2024-05-23","2025-12-26","2024-07-09","2024-07-09","2025-03-17","2025-03-17","2025-03-17","2025-06-27","2025-07-16","2025-07-16","2025-07-16","2025-12-26","2025-12-26","2024-04-10","2024-10-16","2024-04-12","2025-09-28","2024-05-20","2025-12-16","2025-12-16","2025-12-16","2026-01-22","2024-10-16","2024-10-15","2025-10-20","2025-10-20","2025-10-20","2025-01-06","2025-01-06","2025-01-06","2025-06-09","2025-06-11","2025-06-11","2025-06-13","2025-06-13","2025-12-26","2025-07-08","2025-07-08","2025-08-15","2025-08-15","2025-08-15","2025-09-16","2025-09-23","2025-09-23","2025-09-23","2025-09-23","2025-09-23","2025-09-23","2025-09-16","2025-09-16","2025-09-16","2025-12-26","2026-01-22"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}