{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Hoa t Phung","gend":1,"currentgend":"","add":"416 ESSEX ST","city":"SALEM","state":"MA","zip":"01970","dob":"1969-12-31","age":"","mstatus":"","insh":"C0003737101","cliId":"","pno":9783359501,"cno":"","email":"","ename":"","eno":"","pphy":"Brent A Fryling","ppno":9787776544,"pcpadd":"5 Federal St,Ste 1","pcpcity":"Danvers","pcpstate":"MA","pcpzip":"01923","pcpcounty":"","pcpid":"","pcpname":"Beth Israel Lahey Health Primary Care ,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"416 ESSEX ST","madd2":"APT 2","madd3":"","mcity":"SALEM","mstate":"MA","mzip":"01970","pcpfaxno":"","pcpnpi":1053369611,"currentgendcomment":"","pphycomment":"","uniqueid":61620651,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","J479","E559","Z0000","R0989","Z1231","J069","G4762","R918","J471","Z5181","Z23","Z130","E538","R350","R5383","Z124","M1711","R52","Z1211","K5730","K644","K641","J4489","Z791","R062","Q893","J40","J0190","B9689","J4531","R92323","Z0001","Z1331","M533","M5416","E8940","Z79890","J189","G8929","K649","J200","L308","K8020","H6502","M25561","M21612","Z01419","M5450","D126","M79605","H2513","D122","K648","Z9189"],"date":["2025-12-08","2025-12-28","2025-07-21","2025-07-21","2024-07-23","2025-07-28","2024-10-15","2024-10-15","2024-10-18","2025-09-22","2024-12-18","2025-09-22","2025-07-21","2025-07-21","2025-07-21","2025-07-21","2025-12-08","2025-09-24","2025-09-24","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2025-10-15","2024-05-29","2024-05-29","2025-08-09","2025-08-09","2024-10-04","2025-07-28","2024-07-17","2025-07-21","2024-07-17","2024-07-17","2024-07-17","2024-07-17","2024-07-17","2025-08-09","2024-10-18","2024-12-27","2024-10-18","2024-10-18","2024-12-27","2025-12-11","2025-02-21","2025-12-08","2025-07-21","2025-07-21","2025-07-21","2025-08-10","2025-10-20","2025-10-20","2025-10-20"],"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":[["","","AZITHROMYCIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","GAVILAX","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","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":""}]}]}