{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan R Doyle","gend":1,"currentgend":"","add":"90 SPRING ST","city":"MARLBOROUGH","state":"MA","zip":"01752","dob":"1972-10-26","age":"","mstatus":"","insh":"C0004128601","cliId":"","pno":7742490664,"cno":"","email":"","ename":"","eno":"","pphy":"Imola Daniel","ppno":5083637300,"pcpadd":"123 Summer St,Ste 385","pcpcity":"Worcester","pcpstate":"MA","pcpzip":"01608","pcpcounty":"","pcpid":"","pcpname":"Partners in Internal Medicine, PC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"90 SPRING ST","madd2":"","madd3":"","mcity":"MARLBOROUGH","mstate":"MA","mzip":"01752","pcpfaxno":"","pcpnpi":1245460609,"currentgendcomment":"","pphycomment":"","uniqueid":62418401,"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","H01009","E559","R413","J4520","J069","R102","R1031","R262","N200","F17210","Z8673","Z7982","Z1211","Z860100","I10","M25471","M7731","Z1231","S0101XA","E785","J45909","Z8719","M25561","I639","Z95818","H18891","E663","Z8249","R7303","L989","I6389","M67471","F411","K582","N3281","J3089","D251","E669","M25551","D229","L821","L814","L918","Z7189","I6782","I6381","Z860101","R933","Z0001","Z0100","H6121","L2989","N610","W57XXXA","M79673","E782","M19071","R92323","K219","M170","R296","H0500","J45901","F10120","R55","Z4802","S0990XA","H01001","M1711","M25461"],"date":["2025-12-17","2025-11-17","2025-12-30","2025-12-17","2025-12-30","2025-11-17","2025-01-21","2025-01-23","2025-01-21","2025-01-21","2025-11-05","2025-01-21","2025-01-21","2025-03-19","2025-03-19","2025-10-13","2025-10-13","2025-10-13","2025-10-20","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-30","2026-01-12","2024-04-30","2024-06-18","2024-10-04","2024-10-04","2024-10-04","2025-10-13","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2025-05-21","2025-01-08","2025-01-21","2025-04-04","2025-04-04","2025-04-04","2025-04-04","2025-04-04","2025-04-04","2025-04-04","2025-03-19","2025-03-19","2025-05-21","2025-05-07","2025-06-06","2025-06-23","2025-08-25","2025-08-25","2025-10-13","2025-10-13","2025-10-13","2025-10-20","2025-12-30","2025-12-30","2025-12-30","2025-10-31","2025-11-17","2025-12-01","2025-12-03","2025-12-10","2025-12-02","2025-10-29","2025-12-30","2025-12-30"],"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",""],["","","ASPIRIN EC","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MIRABEGRON ER","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","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":""}]}]}