{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alyshea Dobo","gend":1,"currentgend":"","add":"127 VERNON ST","city":"GARDNER","state":"MA","zip":"01440","dob":"1988-10-13","age":"","mstatus":"","insh":"C0032894000","cliId":"","pno":7742084261,"cno":"","email":"","ename":"","eno":"","pphy":"Owen G Debowy","ppno":5088096378,"pcpadd":"60 Messenger St,Ste 201","pcpcity":"Plainville","pcpstate":"MA","pcpzip":"02762","pcpcounty":"","pcpid":"","pcpname":"Sturdy Memorial Associates, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"127 VERNON ST","madd2":"","madd3":"","mcity":"GARDNER","mstate":"MA","mzip":"01440","pcpfaxno":"","pcpnpi":1518126713,"currentgendcomment":"","pphycomment":"","uniqueid":144298050,"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":[]},{"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":[["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","NORETHINDRONE ACETATE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","UBRELVY","","","Select","Select",""],["","","NUCALA","","","Select","Select",""],["","","EMGALITY PEN","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","TIROSINT","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","URSODIOL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","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":""}]}]}