{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Fatemeh Mohammadi","gend":1,"currentgend":"","add":"24 PARLMONT PARK","city":"N BILLERICA","state":"MA","zip":"01862","dob":"1976-09-21","age":"","mstatus":"","insh":"C0001341001","cliId":"","pno":6175711349,"cno":"","email":"","ename":"","eno":"","pphy":"Rand Nashi","ppno":3392155100,"pcpadd":"55 North Rd,Ste 120","pcpcity":"Bedford","pcpstate":"MA","pcpzip":"01730","pcpcounty":"","pcpid":"","pcpname":"Emerson Practice Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"BLDG 1","add3":"","madd1":"24 PARLMONT PARK","madd2":"BLDG 1","madd3":"","mcity":"N BILLERICA","mstate":"MA","mzip":"01862","pcpfaxno":"","pcpnpi":1215399829,"currentgendcomment":"","pphycomment":"","uniqueid":56540001,"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","M26609","J0101","E28319","M542","R519","M2669","J320","Z1231","H9203","H9313","M79645","Z0000","R61","M778","M25511","M25532","M4723","R92333","S0300XA","Z01419","R6882","Z23","F419","F3341","K219","H524","R6889","J069","M47812","M50222","M50321","M50322","M50323","M4802","M50223","M5416","M5412","M5116","M47893","M4722","H6502","J309","R109","N809","U071","M67834"],"date":["2025-11-11","2024-02-21","2024-05-13","2025-08-13","2025-03-18","2024-03-13","2024-06-03","2024-06-03","2025-04-26","2024-04-19","2024-04-19","2024-07-06","2025-11-19","2024-09-24","2024-12-13","2024-12-13","2024-12-13","2025-04-14","2025-04-26","2024-02-21","2024-07-10","2024-07-10","2024-09-24","2025-11-19","2024-09-24","2025-11-19","2024-11-10","2024-01-10","2025-04-02","2025-03-25","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-03-20","2025-03-25","2025-03-20","2025-04-14","2025-04-14","2025-06-05","2025-06-05","2025-10-06","2025-11-19","2025-03-12","2024-12-13"],"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":[["","","PROGESTERONE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","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":""}]}]}