{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lauryn S Simoes","gend":1,"currentgend":"","add":"15 DARTMOUTH ST","city":"TAUNTON","state":"MA","zip":"02780","dob":"2002-05-14","age":"","mstatus":"","insh":"C0032362200","cliId":"","pno":5088132190,"cno":"","email":"","ename":"","eno":"","pphy":"Amanda C Costa","ppno":5088940400,"pcpadd":"1215 Broadway,","pcpcity":"Raynham","pcpstate":"MA","pcpzip":"02767","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 DARTMOUTH ST","madd2":"","madd3":"","mcity":"TAUNTON","mstate":"MA","mzip":"02780","pcpfaxno":"","pcpnpi":1841541109,"currentgendcomment":"","pphycomment":"","uniqueid":143160300,"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","R399","G43109","F419","G43909","Z3041","B379","Z308","F32A","F418","K769","R7989","B349","R059","R5383","I10","Z0000","E785","L2989","E669","Z6836","H6121","Z803","N644","Z853","Z6837","N6459","Z3490","N912","Z6832","O358XX0","O352XX0","Z8279","O359XX0","Z3A30","O99413","O09899","O35BXX1","O0930","Z363","O99213","Z3A29","O0933","Z3A33","O26893","Z3A32","Z0373","Z3A31","Z3403","Z3A36","O99211","O99891","R030","Z3A38","O133","O480","O99824","Z370","Z3A41","Z23","O163","Z3A40","M5450","M62838","N949","J029","R52","R509","Z880","Z8249","Z83430","E559","Z3481","Z369","Z3402","Z3492","B951","Z3A37","O26843","O99210","O43893","O43899","Z3A34","Z391"],"date":["2025-12-15","2024-09-12","2025-07-17","2025-08-28","2025-08-28","2025-06-18","2025-09-02","2026-02-01","2025-08-28","2024-10-07","2024-11-07","2025-04-15","2025-04-02","2025-04-07","2025-04-07","2025-12-01","2025-04-15","2025-04-15","2025-05-20","2025-08-28","2025-04-15","2025-04-15","2025-06-04","2025-04-28","2025-04-28","2025-05-20","2025-06-04","2025-08-28","2025-09-05","2025-08-28","2025-10-01","2025-10-01","2025-10-09","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2025-09-25","2025-09-25","2025-11-17","2025-09-25","2025-10-23","2025-10-23","2025-10-16","2025-10-16","2025-10-09","2025-10-09","2025-11-10","2025-11-10","2025-12-01","2025-11-26","2025-11-26","2025-11-26","2025-11-26","2025-12-13","2025-12-12","2025-12-13","2025-12-13","2025-12-12","2025-12-08","2025-12-08","2024-08-14","2024-08-14","2024-09-11","2025-04-02","2025-04-02","2025-04-07","2025-06-04","2025-06-04","2025-06-04","2025-08-29","2025-08-29","2025-09-26","2025-09-05","2025-09-05","2025-11-17","2025-11-17","2025-12-08","2025-12-08","2025-12-13","2025-12-13","2025-10-30","2025-11-19"],"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":[["","","LO LOESTRIN FE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","TERCONAZOLE","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","LABETALOL 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":""}]}]}