{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kelly Sweetser","gend":1,"currentgend":"","add":"16 SAVORY XING","city":"NORTH OXFORD","state":"MA","zip":"01537","dob":"1986-12-18","age":"","mstatus":"","insh":"C0030611100","cliId":"","pno":"7818124015","cno":"","email":"","ename":"","eno":"","pphy":"Iwona  Prabucka-Davis","ppno":"5087969211","pcpadd":"489 Washington St, Ste 202","pcpcity":"Auburn","pcpstate":"MA","pcpzip":"01501","pcpcounty":"","pcpid":"","pcpname":"Auburn Primary Care and Aesthetics LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 SAVORY XING","madd2":"","madd3":"","mcity":"NORTH OXFORD","mstate":"MA","mzip":"01537","pcpfaxno":"","pcpnpi":"1518596642","currentgendcomment":"","pphycomment":"","uniqueid":"139923650","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":["R99","F32A","O368330","Z3A36","O99824","Z370","O701","Z880","Z3A38","N83201","Z3A32","Z3483","Z3A33","Z3A35","Z3490","O09523","O43893","Z3A37","O623","O722","N939","Z392","Z309","N898","Z3040","R519","E559","R5383","R002","Z0000","R7401","K760","D539","N951","D259","N83291","N925","N840","F1011","Z391"],"date":["2024-06-26","2025-07-11","2024-04-29","2024-04-29","2024-05-15","2024-05-15","2024-05-15","2024-05-14","2024-05-15","2025-07-29","2024-04-02","2024-04-29","2024-04-11","2024-04-29","2024-04-29","2024-05-15","2024-05-09","2024-05-09","2024-05-15","2024-05-28","2025-06-12","2024-06-26","2024-06-26","2024-06-26","2024-06-26","2024-11-08","2024-10-25","2024-10-25","2024-10-25","2024-10-25","2024-11-26","2024-11-26","2024-11-26","2025-03-20","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2025-07-11","2024-04-16"],"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":[["","","MEDROXYPROGESTERONE ACETATE","","","Select","Select",""],["","","SERTRALINE HCL","","","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":""}]}]}