{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wendy Laliberte","gend":1,"currentgend":"","add":"81 HARRINGTON ST","city":"ATHOL","state":"MA","zip":"01331","dob":"1974-11-05","age":"","mstatus":"","insh":"C0026766300","cliId":"","pno":9787903064,"cno":"","email":"","ename":"","eno":"","pphy":"Kelly M Clow","ppno":9789392133,"pcpadd":"570 Baldwinville Rd,","pcpcity":"Baldwinville","pcpstate":"MA","pcpzip":"01436","pcpcounty":"","pcpid":"","pcpname":"Mountain View Family Practice, PC","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"81 HARRINGTON ST","madd2":"","madd3":"","mcity":"ATHOL","mstate":"MA","mzip":"01331","pcpfaxno":"","pcpnpi":1942535653,"currentgendcomment":"","pphycomment":"","uniqueid":112080300,"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":["K219","F411","B009","L218","H6992","Z86718","M79605","I82402","Z1231","R92333","Z0000","M79652","Z79899","E042","I2510","Z9049","R918","R399","R7301","M6208","M5450","Z7189","R2242","I8392","Z87891","D152","R002","Z2820","R21","L818","L209","M542","M5451","Q7649","Z1331","E6609","Z6830","M2141","M2142","L309","L403","R197","R110","F341","Z713","Z0001","R600","D696","R7989","Z23","E663","Z6829"],"date":["2025-12-23","2025-12-08","2025-04-11","2025-03-05","2024-03-11","2024-11-15","2024-11-03","2024-09-03","2025-04-25","2025-04-25","2025-08-26","2024-08-09","2024-08-09","2024-10-29","2025-08-09","2024-10-29","2024-10-29","2024-11-26","2025-08-26","2024-03-04","2024-02-16","2025-08-20","2024-03-04","2024-03-04","2025-08-20","2024-03-04","2024-03-04","2024-03-04","2024-04-06","2024-04-06","2024-04-06","2024-08-26","2024-08-26","2024-08-26","2025-08-09","2024-08-26","2024-08-26","2024-08-26","2024-08-26","2024-08-26","2024-08-26","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-08-09","2025-08-09","2025-08-09","2025-08-09","2025-08-09","2025-08-09","2025-08-09"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","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":""}]}]}