{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn Marie Naffah","gend":1,"currentgend":"","add":"142 Pleasant Valley Street","city":"Methuen","state":"MA","zip":"01844","dob":"1979-06-19","age":"","mstatus":"","insh":"C0035345700","cliId":"","pno":5086335717,"cno":"","email":"","ename":"","eno":"","pphy":"Tapasya Srivastava","ppno":9787835000,"pcpadd":"323 Lowell St,","pcpcity":"Andover","pcpstate":"MA","pcpzip":"01810","pcpcounty":"","pcpid":"","pcpname":"Partners Community Physicians Organization Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"Unit# 150304","add3":"","madd1":"142 Pleasant Valley Street","madd2":"Unit# 150304","madd3":"","mcity":"Methuen","mstate":"MA","mzip":"01844","pcpfaxno":"","pcpnpi":1467573527,"currentgendcomment":"","pphycomment":"","uniqueid":148762700,"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":["R079","R791","R918","R1084","R194","K582","K2100","K2970","B9681","R0789","R030","Z0000","E66812","E7800","M722","Z6835","K5730","Z3042","K3189","K2950","F430","D123","D124","J45909","K2090","E669","M5441","M47816","M4317","R12","M47819","M25511","M25512","M7582","M7581","M7732","M19071","M7731","E559","E781","D72828","Z79899","Z9189","Z6830","L918","L219","L820","L700","R99","K580","D125","K640","K259","R1013","R52"],"date":["2025-02-24","2025-02-24","2025-02-24","2025-11-20","2025-08-15","2025-03-21","2025-08-15","2025-05-07","2025-03-21","2025-02-24","2025-04-09","2025-04-16","2025-12-10","2025-04-09","2025-11-20","2025-04-09","2025-04-16","2025-04-02","2025-05-07","2025-05-07","2025-01-29","2025-01-29","2025-01-29","2025-05-07","2025-05-07","2025-05-07","2025-06-11","2026-01-29","2025-10-06","2025-08-15","2025-10-06","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-20","2025-11-20","2025-11-20","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2026-02-24","2025-03-21","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2026-01-13"],"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",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MEDROXYPROGESTERONE ACETATE","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","POLYETHYLENE GLYCOL 3350","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","PHENTERMINE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","TRETINOIN","","","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":""}]}]}