{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Evangelia Loris","gend":1,"currentgend":"","add":"27 JACOBS ST","city":"PEABODY","state":"MA","zip":"01960","dob":"1966-04-17","age":"","mstatus":"","insh":"C0017732200","cliId":"","pno":"9788765645","cno":"","email":"","ename":"","eno":"","pphy":"Jonathan R Snyder","ppno":"9782790800","pcpadd":"100 Cummings Ctr, Ste 136P","pcpcity":"Beverly","pcpstate":"MA","pcpzip":"01915","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":"27 JACOBS ST","madd2":"","madd3":"","mcity":"PEABODY","mstate":"MA","mzip":"01960","pcpfaxno":"","pcpnpi":"1326243775","currentgendcomment":"","pphycomment":"","uniqueid":"93581150","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Greek"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66812","R110","N390","R99","Z96659","H2513","N200","Z87442","N952","Z0000","E66811","E6609","M25562","G8929","M5450","Z6833","Z1231","M48062","M5416","Z96653","Z96652","Z96651","Z6835","Z23","Z6834","M2391","M170","M179","M1711","R399","K219","E66813","R635","M7989","E6601","R030","Z6841","M47816","Z1211","D120","K621","K648","Z860100","T8484XD","Z6838","Z01419","Z1151","Z09","T8484XS","Z87891","R8281","F39","M4807","M5127","M51362","M4726","M4316","M48061","K635","D251","M7652","M9903","M5417","M9904","M5418","Z124","L659","K5909","Z6837"],"date":["2025-10-27","2025-11-21","2026-03-14","2026-05-15","2026-02-09","2025-07-30","2025-11-18","2025-12-01","2025-12-01","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-04-23","2026-03-25","2026-05-06","2025-07-09","2025-12-01","2025-12-01","2025-08-18","2026-03-11","2025-11-21","2025-05-21","2025-05-21","2024-08-22","2024-08-26","2024-08-14","2025-05-13","2025-04-25","2024-07-30","2024-08-14","2025-02-13","2024-08-14","2025-02-13","2025-04-13","2025-04-23","2025-04-23","2025-04-23","2025-04-23","2025-04-23","2025-05-13","2025-05-13","2025-05-12","2025-05-12","2025-05-22","2024-07-11","2024-07-11","2025-05-29","2025-02-13","2025-04-13","2025-04-13","2025-04-13","2025-04-13","2025-04-13","2025-04-13","2025-04-23","2025-05-12","2025-05-21","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2025-05-12","2025-06-25","2025-06-25","2025-06-25"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","IBUPROFEN","","","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":""}]}]}