{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen Tredwell","gend":1,"currentgend":"","add":"80 FRONT ST","city":"MARBLEHEAD","state":"MA","zip":"01945","dob":"1972-01-02","age":"","mstatus":"","insh":"C0033055700","cliId":"","pno":7812489839,"cno":"","email":"","ename":"","eno":"","pphy":"Srivalli Konduri","ppno":9785326111,"pcpadd":"2 Corporation Way,Ste 180","pcpcity":"Peabody","pcpstate":"MA","pcpzip":"01960","pcpcounty":"","pcpid":"","pcpname":"North Shore Physicians Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"80 FRONT ST","madd2":"","madd3":"","mcity":"MARBLEHEAD","mstate":"MA","mzip":"01945","pcpfaxno":"","pcpnpi":1417187386,"currentgendcomment":"","pphycomment":"","uniqueid":144637750,"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":["R059","M79671","Z01419","Z1151","Z1231","Z1211","K640","K5730","Z83719","Z860100","Z0000","F1090","D1803","F418","Z85820","Z780","J40","Z23","L578","L718","D225","L821","Z08","Z808","B078","L0889","L538","R238","R051","J321","J9801","J0110","J069","M778","M7741","M7662","L600","Z124","M25572","M25672","R531","H524","Z135","Z0001","R99","E559"],"date":["2025-06-12","2025-10-20","2025-07-31","2025-07-31","2025-09-16","2025-12-12","2025-12-12","2025-12-12","2025-12-12","2025-12-12","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2026-02-03","2024-12-18","2025-01-10","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2025-06-07","2025-07-08","2025-09-25","2025-09-25","2025-07-21","2025-07-31","2025-10-20","2025-10-20","2025-10-20","2025-09-03","2025-09-03","2025-12-15","2025-12-15","2024-09-09"],"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":[["","","METRONIDAZOLE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","GUAIFENESIN-CODEINE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","DISULFIRAM","","","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":""}]}]}