{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Annamarie R Shu","gend":1,"currentgend":"","add":"120 TRENTON ST","city":"MELROSE","state":"MA","zip":"02176","dob":"1962-02-06","age":"","mstatus":"","insh":"C0031438700","cliId":"","pno":"7816658589","cno":"","email":"","ename":"","eno":"","pphy":"Kristyn  Newhall","ppno":"7813387400","pcpadd":"178 Savin St, Ste 100","pcpcity":"Malden","pcpstate":"MA","pcpzip":"02148","pcpcounty":"","pcpid":"","pcpname":"Hallmark Health Medical Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"120 TRENTON ST","madd2":"","madd3":"","mcity":"MELROSE","mstate":"MA","mzip":"02176","pcpfaxno":"","pcpnpi":"1275760027","currentgendcomment":"","pphycomment":"","uniqueid":"141500850","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":["F419","F331","Z1211","R99","L290","Z7184","K6389","E785","Z800","Z860101","Z1231","L659","Z0000","R739","E559","E539","R109","E782","Z860100","Q438","R92323","Z2989","H25093","H5213","H52203","H524","H43812","N6489","Z23","Z1331","M5489","M25561","G8929","M1711","R7401","R928","R92321","G4700"],"date":["2026-05-08","2026-05-05","2025-11-25","2025-10-25","2026-01-19","2026-04-07","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-12-18","2025-11-12","2025-11-12","2025-11-12","2025-11-12","2025-11-12","2025-11-12","2025-11-12","2025-11-25","2025-11-25","2025-12-18","2025-06-11","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2025-01-02","2025-01-13","2024-11-11","2024-11-11","2024-11-18","2024-11-18","2024-11-18","2024-12-02","2025-01-02","2025-01-02","2025-06-11"],"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":[["","","CLONAZEPAM","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ACETAZOLAMIDE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","ATOVAQUONE-PROGUANIL 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":""}]}]}