{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martine Estine","gend":1,"currentgend":"","add":"28 MEADOW LN","city":"BRIDGEWATER","state":"MA","zip":"02324","dob":"1966-03-01","age":"","mstatus":"","insh":"C0034520300","cliId":"","pno":"5615770641","cno":"","email":"","ename":"","eno":"","pphy":"Akash D Patel","ppno":"7815275310","pcpadd":"401 N Bedford St","pcpcity":"East Bridgewater","pcpstate":"MA","pcpzip":"02333","pcpcounty":"","pcpid":"","pcpname":"Nova Medical Group PC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 10","add3":"","madd1":"28 MEADOW LN","madd2":"APT 10","madd3":"","mcity":"BRIDGEWATER","mstate":"MA","mzip":"02324","pcpfaxno":"","pcpnpi":"1609032580","currentgendcomment":"","pphycomment":"","uniqueid":"147235350","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":["I10","E119","E785","G44311","R99","R739","A4189","J1000","J188","E1110","Z79899","Z7984","R059","Z113","N898","N83291","D259","R5383","Z23","M25511","Z7189","Z5189","E1165","R000","R051","R531","M7541","M7542","R918","S46011D","S46012D","M47814","S0990XA","R519","R936","R42","Z0001","Z1231","Z1211","Z124","Z1330","Z7185","Z1159"],"date":["2026-03-29","2026-05-24","2026-03-29","2025-12-09","2026-05-26","2025-12-16","2025-12-26","2025-12-23","2025-12-23","2025-12-23","2025-12-23","2025-12-23","2026-01-02","2026-03-09","2026-03-16","2026-04-03","2026-04-03","2025-10-21","2026-03-16","2025-12-09","2025-12-09","2025-12-09","2025-12-16","2025-12-22","2026-01-02","2025-12-22","2026-01-14","2026-01-14","2025-12-22","2026-04-22","2026-04-22","2026-01-02","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2026-03-16"],"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":[["","","ASPIRIN","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","FREESTYLE INSULINX","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","ALCOHOL PREP PADS","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","HUMALOG KWIKPEN U-100","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","NANO PEN NEEDLE","","","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":""}]}]}