{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen Pickett","gend":1,"currentgend":"","add":"5 MacArthur Rd","city":"North Reading","state":"MA","zip":"01864","dob":"1968-10-15","age":"","mstatus":"","insh":"C0031438401","cliId":"","pno":"6178218833","cno":"","email":"","ename":"","eno":"","pphy":"Dana A Mann","ppno":"9787742555","pcpadd":"147 S Main St","pcpcity":"Middleton","pcpstate":"MA","pcpzip":"01949","pcpcounty":"","pcpid":"","pcpname":"Middleton Family Medicine Urgent Care, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 MacArthur Rd","madd2":"","madd3":"","mcity":"North Reading","mstate":"MA","mzip":"01864","pcpfaxno":"","pcpnpi":"1679764161","currentgendcomment":"","pphycomment":"","uniqueid":"141500701","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","E1165","I10","R99","E1121","E782","N1832","E113299","E1122","E785","F419","E663","Z0000","Z1239","Z1211","Z1331","Z23","Z1283","I129","Z6827","Z87891","N1831","Z7984"],"date":["2025-07-17","2026-05-08","2026-04-10","2026-04-12","2026-05-29","2025-08-01","2026-04-10","2026-04-10","2025-08-05","2026-04-10","2025-03-20","2025-03-20","2024-10-16","2024-10-16","2024-10-16","2024-10-16","2024-10-16","2024-10-16","2025-03-20","2025-03-20","2025-02-28","2025-03-20","2025-03-20"],"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":[["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","HUMALOG KWIKPEN U-100","","","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":""}]}]}