{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ama P Nugent","gend":1,"currentgend":"","add":"8 WILLVAIL ST","city":"WORCESTER","state":"MA","zip":"01603","dob":"1968-07-28","age":"","mstatus":"","insh":"C0035331201","cliId":"","pno":"5086157086","cno":"","email":"","ename":"","eno":"","pphy":"Tatyana  Sayko","ppno":"5088320173","pcpadd":"813 Southbridge St","pcpcity":"Auburn","pcpstate":"MA","pcpzip":"01501","pcpcounty":"","pcpid":"","pcpname":"St. Vincent Physician Services, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 WILLVAIL ST","madd2":"","madd3":"","mcity":"WORCESTER","mstate":"MA","mzip":"01603","pcpfaxno":"","pcpnpi":"1750392700","currentgendcomment":"","pphycomment":"","uniqueid":"148755551","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S060XAA","M62838","I10","Z79899","M5410","Z0000","R051","M549","J45909","Z6831","H401211","H25813","E6689","E7849","R7303","L700","K219","Z6830","D582","M5450","M542","R519","S3992XA","M5413","M5416","R531","Z0100","Z6828","M5116","M5117","M48061","M4807","W010XXA","Z124","J302","Z23","Z1331","D649","H401290","G4709","R99","H4012","E669","Z2989","Z1231","R92323"],"date":["2025-03-03","2025-03-03","2025-09-29","2025-03-03","2025-07-11","2025-09-29","2025-04-12","2025-01-13","2025-03-31","2025-01-13","2026-01-15","2025-10-06","2025-10-20","2025-09-08","2025-09-29","2026-01-10","2025-03-31","2025-03-31","2025-09-29","2025-03-31","2025-03-31","2025-03-03","2025-03-03","2025-08-01","2025-08-01","2025-08-01","2025-06-03","2025-09-29","2025-07-11","2025-07-11","2025-07-11","2025-07-11","2025-03-03","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2026-02-27","2025-01-26","2025-08-28","2025-09-29","2025-04-02","2025-04-02"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATOVAQUONE-PROGUANIL HCL","","","Select","Select",""],["","","BRIMONIDINE TARTRATE-TIMOLOL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","HEPLISAV-B","","","Select","Select",""],["","","PREVNAR 20","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}