{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Crystal R Woodward","gend":1,"currentgend":"","add":"128 DANIELS ST","city":"FITCHBURG","state":"MA","zip":"01420","dob":"2001-03-21","age":"","mstatus":"","insh":"C0027460900","cliId":"","pno":"9783999887","cno":"","email":"","ename":"","eno":"","pphy":"Rao  Keerthana","ppno":"9788788100","pcpadd":"165 Mill St","pcpcity":"Leominster","pcpstate":"MA","pcpzip":"01453","pcpcounty":"","pcpid":"","pcpname":"Community Health Connections, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 2L","add3":"","madd1":"128 DANIELS ST","madd2":"APT 2L","madd3":"","mcity":"FITCHBURG","mstate":"MA","mzip":"01420","pcpfaxno":"","pcpnpi":"1780492223","currentgendcomment":"","pphycomment":"","uniqueid":"133020000","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":["Z3490","Z3400","O42912","Z87891","Z3A27","O26893","Z3A38","O471","O26853","O99820","Z3A39","O135","R42","R531","O480","Z370","O99344","F32A","Z3A40","O99824","O701","O134","O43193","R112","Z3201","Z3687","Z3A08","Z114","Z3A10","Z23","Z862","Z0189","Z0001","Z13220","Z131","Z1159","Z113","Z3A16","Z3689","Z3A20","Z0371","Z1332","Z3A28","R7309","O4693","O80","Z391","R55","S0990XA","F419","R519","F17290","Z6823","E639","Z1331","Z1389"],"date":["2026-02-14","2026-04-03","2026-01-30","2026-05-08","2026-01-30","2026-04-20","2026-04-20","2026-04-20","2026-04-29","2026-04-29","2026-04-29","2026-05-08","2026-05-08","2026-05-08","2026-05-05","2026-05-05","2026-05-04","2026-05-04","2026-05-05","2026-05-05","2026-05-05","2026-05-04","2026-05-05","2025-08-06","2025-09-19","2025-09-19","2025-09-19","2025-10-02","2025-10-02","2026-02-06","2025-10-02","2025-10-02","2025-10-02","2025-10-02","2026-02-06","2025-10-02","2025-10-02","2025-11-14","2026-04-29","2025-12-12","2026-01-30","2026-02-06","2026-02-06","2026-02-14","2026-04-29","2026-05-04","2026-02-11","2024-08-05","2024-11-12","2024-11-12","2024-07-10","2024-09-26","2024-09-26","2024-09-26","2024-08-05","2024-08-05"],"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":[]},{"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":""}]}]}