{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ana Y Jimenez","gend":1,"currentgend":"","add":"3 MOODY AVE","city":"METHUEN","state":"MA","zip":"01844","dob":"1978-07-14","age":"","mstatus":"","insh":"C0000414000","cliId":"","pno":9788854035,"cno":"","email":"","ename":"","eno":"","pphy":"Vani S Reddi","ppno":9787253636,"pcpadd":"451 Andover St,Ste 206","pcpcity":"North Andover","pcpstate":"MA","pcpzip":"01845","pcpcounty":"","pcpid":"","pcpname":"Essex Medical Associates, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 MOODY AVE","madd2":"","madd3":"","mcity":"METHUEN","mstate":"MA","mzip":"01844","pcpfaxno":"","pcpnpi":1407803299,"currentgendcomment":"","pphycomment":"","uniqueid":52065700,"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","G4700","N946","E6609","J45901","J0190","R99","R110","Z1231","R310","Z1211","K648","Z7985","Z800","N201","J45909","K219","N132","N202","N3592","N200","F332","F4310","F331","F411","L299","R233","N912","M2520","M25569","G43909","E6601","Z6834","Z713","Z7182","R194","K921","Z0000","R319","Z0110","Z1331","R202","R92333","K625","Z87442","R8290","Z01419","Z0100","I959","N390","N1330","N83201","Z466","Z960","E663","N3289","Z09"],"date":["2024-07-18","2024-07-18","2024-07-18","2025-10-30","2025-03-13","2024-11-14","2026-01-04","2025-01-03","2025-03-22","2025-05-02","2025-05-16","2025-05-16","2025-05-16","2025-05-16","2025-12-07","2026-01-29","2025-12-07","2026-01-08","2025-12-16","2025-12-16","2026-01-29","2025-10-01","2025-10-08","2026-01-20","2025-12-03","2024-07-03","2024-07-08","2024-07-03","2024-07-18","2024-07-18","2026-01-29","2026-01-29","2026-01-29","2026-01-29","2026-01-29","2025-02-20","2025-02-20","2025-03-13","2025-03-19","2025-03-13","2025-03-13","2025-03-13","2025-03-22","2025-05-16","2026-01-23","2025-08-21","2025-08-21","2025-09-23","2025-09-25","2025-11-11","2025-12-07","2026-01-13","2025-12-16","2026-01-08","2026-01-29","2026-01-08","2026-01-23"],"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":[["","","BUPROPION XL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUZONE 2025-2026","","","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":""}]}]}