{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Zohreh Beheshti","gend":1,"currentgend":"","add":"260 FOREST ST","city":"WALTHAM","state":"MA","zip":"02452","dob":"1973-11-13","age":"","mstatus":"","insh":"C0023366601","cliId":"","pno":6173199876,"cno":"","email":"","ename":"","eno":"","pphy":"Lydia Flier","ppno":6174995055,"pcpadd":"330 Mount Auburn St,","pcpcity":"Cambridge","pcpstate":"MA","pcpzip":"02138","pcpcounty":"","pcpid":"","pcpname":"Mount Auburn Professional","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"260 FOREST ST","madd2":"","madd3":"","mcity":"WALTHAM","mstate":"MA","mzip":"02452","pcpfaxno":"","pcpnpi":1104273911,"currentgendcomment":"","pphycomment":"","uniqueid":105044801,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25871","J3089","J301","R2241","G8918","M19071","M7671","M25471","G5790","M65971","M65979","J3081","M4712","M6788","R200","M542","M79641","M79642","Z0001","Z23","Z90710","E663","Z6827","I959","R4189","G479","Z833","B009","R99","T8140XA","L0390","G4701","M546","N951","Z0000","E538","Z8719","E781","Z6830","S93491A","S86311A","M67873","R600","M25571","M25561","M25562","R1013","R112","Z1231","R0789","M25371","M79661","M4722","H1045","M65871","G8929","L819","Z98890","G608","R0781"],"date":["2025-12-08","2025-12-05","2025-12-05","2025-02-26","2025-04-01","2025-05-15","2025-10-12","2025-02-26","2025-07-05","2025-10-12","2025-10-12","2025-06-26","2025-07-18","2025-10-12","2025-08-29","2025-07-18","2025-07-18","2025-07-18","2025-08-29","2025-10-21","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2024-09-16","2025-11-17","2025-04-01","2025-01-13","2025-02-13","2025-02-24","2025-12-24","2025-08-29","2024-08-28","2024-08-28","2024-08-28","2024-08-28","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-02-10","2024-02-10","2024-09-30","2024-09-30","2025-02-14","2025-02-24","2025-06-01","2025-02-26","2025-07-18","2024-12-09","2024-05-12","2025-02-24","2025-02-24","2025-02-24","2025-03-14","2025-02-24"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","CONTRAVE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ESTRADIOL (ONCE WEEKLY)","","","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":""}]}]}