{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane Elsner","gend":1,"currentgend":"","add":"12 Old Cedar Village","city":"Bridgewater","state":"MA","zip":"02324","dob":"1969-02-09","age":"","mstatus":"","insh":"C0027590300","cliId":"","pno":"5089675321","cno":"","email":"","ename":"","eno":"","pphy":"John K Terzian","ppno":"5085831100","pcpadd":"711 W Center St","pcpcity":"West Bridgewater","pcpstate":"MA","pcpzip":"02379","pcpcounty":"","pcpid":"","pcpname":"Bridgewater Primary Care and Cardiology, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 Old Cedar Village","madd2":"","madd3":"","mcity":"Bridgewater","mstate":"MA","mzip":"02324","pcpfaxno":"","pcpnpi":"1619963337","currentgendcomment":"","pphycomment":"","uniqueid":"133522150","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":["F418","F5104","E890","M810","R99","F5101","F419","L03019","E785","Z85850","Z13820","Z1231","R9431","R079","R0600","R0989","I340","I361","I77810","I739","I459","Z136","Z131","H903","E039","D649","Z0000","I4710","F4322","G4700","Z87891","L0390","J449","Z139","R5383","E559"],"date":["2026-05-18","2026-01-24","2025-08-25","2026-04-15","2026-05-18","2026-05-12","2026-02-23","2026-02-02","2026-05-18","2025-11-19","2026-01-09","2026-01-22","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2025-11-21","2026-02-26","2026-02-26","2025-08-06","2026-02-20","2026-02-20","2026-02-20","2026-02-26","2026-05-08","2025-01-17","2024-09-22","2025-01-17","2025-06-19","2024-11-15","2025-04-18","2024-11-15"],"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":[["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","NICOTINE LOZENGE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NEXLETOL","","","Select","Select",""],["","","EZETIMIBE","","","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":""}]}]}