{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeanne Muse","gend":1,"currentgend":"","add":"17 BERRYWOOD LN","city":"BEVERLY","state":"MA","zip":"01915","dob":"1963-07-19","age":"","mstatus":"","insh":"C0017018600","cliId":"","pno":"9785781740","cno":"","email":"","ename":"","eno":"","pphy":"Anil K Dubey","ppno":"9787451200","pcpadd":"331 Highland Ave","pcpcity":"Salem","pcpstate":"MA","pcpzip":"01970","pcpcounty":"","pcpid":"","pcpname":"North Shore Physicians Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"17 BERRYWOOD LN","madd2":"","madd3":"","mcity":"BEVERLY","mstate":"MA","mzip":"01915","pcpfaxno":"","pcpnpi":"1528077666","currentgendcomment":"","pphycomment":"","uniqueid":"92536350","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":["C50911","C50912","E119","G43909","Z7984","Z885","Z886","Z7901","Z170","Z1721","Z1732","Z87891","E538","E139","G4730","D225","L821","L814","L811","L573","E1165","G4719","G4700","L259","K130","F900","Z1231","K760","R921","N6311","D0511","D0512","M50323","M51360","M5134","M542","C50411","N6022","G8918","Z9013","K047","R300","R99","Z79890","N952","B379","M7542","N390","Z4889","K769","M65331","R350","N3946","N816","M65332","Z01419","Z8742","R140","R9230","Z0000","B3731","R3911","Z01818","N3281","H5203","H04123","N393","M65312","M79641","M6530","L0201","N6489","R160","E7800","M65842","R3915","K219","Z9049","Z9851","Z79899","R739","Z1159","N812","N814","E1122"],"date":["2026-03-20","2026-03-20","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-04-17","2026-03-03","2026-03-03","2026-03-03","2026-04-17","2025-07-17","2025-07-16","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2026-03-20","2025-10-01","2025-10-01","2025-10-06","2025-10-06","2025-10-06","2025-12-11","2025-12-17","2026-01-28","2026-01-09","2026-02-10","2026-03-19","2026-02-12","2026-02-12","2026-02-12","2026-02-12","2026-04-17","2026-01-28","2026-03-03","2026-03-03","2026-03-20","2026-04-09","2026-05-29","2026-05-27","2025-09-24","2026-04-15","2026-01-22","2026-04-10","2026-03-19","2025-01-27","2025-06-04","2025-03-21","2025-03-21","2025-03-21","2025-06-04","2025-03-06","2025-03-06","2025-03-18","2025-03-06","2025-03-07","2025-03-07","2025-03-11","2025-03-07","2025-03-17","2025-05-02","2025-05-02","2025-04-29","2025-06-04","2025-06-04","2025-06-04","2025-06-13","2024-11-26","2025-01-27","2024-12-27","2025-01-21","2025-03-07","2025-03-21","2025-03-21","2025-03-21","2025-03-21","2025-06-30","2025-06-30","2024-11-20","2024-12-10","2024-12-10"],"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":[["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ESTRADIOL (TWICE WEEKLY)","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","FLUZONE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","HUMALOG KWIKPEN U-200","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","DEXCOM G7 15 DAY SENSOR","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AFLURIA TRIV 2024-25 (3YR UP)","","","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":""}]}]}