{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane A Harness","gend":1,"currentgend":"","add":"19 Tomlin Street","city":"Waltham","state":"MA","zip":"02451","dob":"1968-10-20","age":"","mstatus":"","insh":"C0038083400","cliId":"","pno":"8572649749","cno":"","email":"","ename":"","eno":"","pphy":"Heather  Lampert","ppno":"6179035000","pcpadd":"74 Central St, Unit B","pcpcity":"Wellesley","pcpstate":"MA","pcpzip":"02482","pcpcounty":"","pcpid":"","pcpname":"Partners Community Physicians Organization Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"19 Tomlin Street","madd2":"","madd3":"","mcity":"Waltham","mstate":"MA","mzip":"02451","pcpfaxno":"","pcpnpi":"1821653486","currentgendcomment":"","pphycomment":"","uniqueid":"152347150","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","N950","J3489","J328","J342","J349","G4730","J343","D251","D252","M419","M7910","M47817","R002","Z8249","I10","E782","N951","S62022D","M1812","S63092D","M25532","E039","N921","R0789","E785","E611","I7300","Z13820","M8580","Z1211","D122","K641","K6389","K562","K635","L570","M25512","M85851","M85852","S62109A","S63092A"],"date":["2026-04-01","2026-04-01","2026-03-04","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-13","2026-03-13","2026-03-20","2026-03-20","2026-03-20","2026-05-04","2026-03-23","2026-04-03","2026-03-23","2026-04-01","2025-07-01","2025-07-01","2025-07-01","2025-07-01","2026-02-20","2026-02-20","2026-04-01","2026-04-01","2026-04-01","2026-04-01","2025-05-14","2025-05-14","2025-06-09","2025-06-09","2025-06-09","2025-06-09","2025-06-09","2025-06-09","2025-04-30","2025-04-30","2025-05-14","2025-05-14","2025-06-05","2025-06-05"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","ESTRADIOL (ONCE WEEKLY)","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","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":""}]}]}