{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christy L Hubbard","gend":1,"currentgend":"","add":"58 MADISON ST","city":"HAVERHILL","state":"MA","zip":"01830","dob":"1971-06-04","age":"","mstatus":"","insh":"C0027226200","cliId":"","pno":"9789940166","cno":"","email":"","ename":"","eno":"","pphy":"Stephen S Berzansky","ppno":"9783527780","pcpadd":"66 E Main St","pcpcity":"Georgetown","pcpstate":"MA","pcpzip":"01833","pcpcounty":"","pcpid":"","pcpname":"Family Care Associates, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"58 MADISON ST","madd2":"","madd3":"","mcity":"HAVERHILL","mstate":"MA","mzip":"01830","pcpfaxno":"","pcpnpi":"1639285133","currentgendcomment":"","pphycomment":"","uniqueid":"131806800","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":["F4322","N951","R99","G43109","L409","G4733","M1712","Z950","Z1231","F329","F909","F50812","F439","R42","H6123","G5761","M205X1","E1100","Z0001","E119","E049","E559","M25561","M25661","M25562","M25462","M25552","Z713","E669","Z9989","Z79899","J449","R92313","Z0101"],"date":["2026-02-03","2026-05-07","2026-05-05","2025-11-10","2025-12-09","2026-04-23","2026-03-16","2026-03-16","2026-05-08","2026-05-05","2026-05-05","2026-05-05","2025-07-02","2025-11-10","2025-07-02","2025-08-15","2025-08-15","2026-05-14","2025-11-10","2025-11-10","2025-11-10","2025-11-10","2026-03-30","2026-03-30","2026-03-16","2026-03-16","2024-07-08","2024-08-16","2024-08-07","2024-08-07","2024-08-07","2024-08-07","2025-01-17","2025-05-12"],"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":[["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","BUTALBITAL-ASPIRIN-CAFFEINE","","","Select","Select",""],["","","FOLIC ACID","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","LISDEXAMFETAMINE DIMESYLATE","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}