{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah J Bourassa","gend":1,"currentgend":"","add":"225 LITTLETON RD","city":"CHELMSFORD","state":"MA","zip":"01824","dob":"1964-12-20","age":"","mstatus":"","insh":"C0027484400","cliId":"","pno":"9789736259","cno":"","email":"","ename":"","eno":"","pphy":"Rekha  Sundar","ppno":"9783230312","pcpadd":"198 Littleton Rd, Ste 102","pcpcity":"Westford","pcpstate":"MA","pcpzip":"01886","pcpcounty":"","pcpid":"","pcpname":"LGH Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 10208","add3":"","madd1":"225 LITTLETON RD","madd2":"APT 10208","madd3":"","mcity":"CHELMSFORD","mstate":"MA","mzip":"01824","pcpfaxno":"","pcpnpi":"1356308597","currentgendcomment":"","pphycomment":"","uniqueid":"133057150","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":["G4733","E6601","R7303","F900","I1A0","I10","R0789","J4520","R99","E782","E119","Z1231","Z23","D751","D229","Z08","Z85828","L570","K7581","F909","F17200","Z9989","Z6837","Z0000","Z1211","Z720","E66812","R92313","Z79899","J410","H60333","R0602","M25551","I119","F17210","E559","D0462","L918","D224","D225","B078","L538","R7989","C44629","M1611","K760","Z1331","Z716"],"date":["2026-05-08","2026-01-13","2025-07-19","2026-05-16","2025-09-18","2026-05-17","2026-04-29","2026-01-13","2026-05-07","2026-05-06","2026-05-07","2026-02-11","2025-07-08","2025-07-16","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-05-06","2025-09-03","2026-01-06","2026-01-22","2026-05-06","2026-01-13","2026-01-23","2026-01-13","2026-05-06","2026-02-11","2026-05-06","2026-05-06","2024-08-07","2025-03-11","2024-12-19","2024-12-27","2024-12-27","2024-10-01","2024-09-24","2024-07-09","2024-09-24","2024-09-24","2025-01-13","2025-01-13","2025-06-03","2024-10-01","2024-12-19","2025-03-14","2025-05-12","2025-06-03"],"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":[["","","VENTOLIN HFA","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","NITROGLYCERIN PATCH","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","LABETALOL HCL","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","HYDROCORTISONE-ACETIC ACID","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","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":""}]}]}