{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kimberly J Lorden","gend":1,"currentgend":"","add":"7 TARRS RD","city":"GLOUCESTER","state":"MA","zip":"01930","dob":"1971-11-19","age":"","mstatus":"","insh":"C0014049500","cliId":"","pno":9788796746,"cno":"","email":"","ename":"","eno":"","pphy":"Erin P Bursey","ppno":9785264311,"pcpadd":"195 School St,","pcpcity":"Manchester","pcpstate":"MA","pcpzip":"01944","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":"","add3":"","madd1":"7 TARRS RD","madd2":"","madd3":"","mcity":"GLOUCESTER","mstate":"MA","mzip":"01930","pcpfaxno":"","pcpnpi":1316375728,"currentgendcomment":"","pphycomment":"","uniqueid":85855850,"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":["Z1231","F4320","F1020","Z01419","Z30011","Z1151","N951","L539","T7840XA","Z6828","Z1331","Z1339","Z0000","I10","R41840","M79674","K649","R9230","M79671","J069","B9789","R21","B3731","R99","Z3041","Z1211","K644","K5730","K648","Z1159","Z124","Z131","Z8349","F32A","F4310","F411","F422","F988","Z79899","Z0001","R4589","Z789"],"date":["2024-12-07","2024-03-07","2025-05-19","2025-11-03","2025-11-19","2025-11-03","2025-11-03","2025-04-21","2025-04-21","2025-04-21","2025-05-19","2025-05-19","2025-05-19","2025-05-19","2025-09-15","2025-05-19","2025-05-19","2025-05-19","2025-03-06","2025-09-06","2025-09-06","2025-06-24","2025-01-07","2025-12-28","2024-05-16","2024-02-02","2024-02-02","2024-02-02","2024-02-02","2024-05-14","2025-11-03","2025-03-06","2025-03-06","2024-12-08","2025-12-08","2025-12-08","2025-03-19","2024-12-02","2024-12-02","2024-05-14","2024-05-14","2024-05-14"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","NORETHINDRONE","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","JUNEL FE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","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":""}]}]}