{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sheldon Knowles","gend":0,"currentgend":"","add":"95 PHILLIPS AVE","city":"ROCKPORT","state":"MA","zip":"01966","dob":"1965-12-09","age":"","mstatus":"","insh":"C0035699200","cliId":"","pno":9784070219,"cno":"","email":"","ename":"","eno":"","pphy":"Howard Libman","ppno":6177549600,"pcpadd":"330 Brookline Ave,E\/Shapiro 6","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02215","pcpcounty":"","pcpid":"","pcpname":"Harvard Medical Faculty Physicians At Beth Israel Medic","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"95 PHILLIPS AVE","madd2":"","madd3":"","mcity":"ROCKPORT","mstate":"MA","mzip":"01966","pcpfaxno":"","pcpnpi":1568520914,"currentgendcomment":"","pphycomment":"","uniqueid":149020050,"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","J22","J1089","B20","J0110","R0981","E291","Z21","Z125","I2510","Z1211","Z860101","E7800","Z0001","J189","I10","K760","N401","B009","R37","D126","D123","D124","Z860109","R070","R051","Z6829","J09X2"],"date":["2025-11-22","2025-02-04","2025-07-07","2025-11-21","2025-04-10","2025-04-10","2025-11-21","2025-09-09","2025-04-03","2025-09-09","2025-11-21","2025-04-03","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2025-11-21","2025-11-21","2025-11-21","2025-02-04","2025-02-04","2025-02-04","2025-07-07"],"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":[["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","TESTOSTERONE CYPIONATE","","","Select","Select",""],["","","LAMIVUDINE-ZIDOVUDINE","","","Select","Select",""],["","","NEVIRAPINE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","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":""}]}]}