{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Monica N Lima","gend":1,"currentgend":"","add":"104 SAVILLE ST","city":"SAUGUS","state":"MA","zip":"01906","dob":"1979-03-10","age":"","mstatus":"","insh":"C0009116300","cliId":"","pno":6178695512,"cno":"","email":"","ename":"","eno":"","pphy":"Elliot J Schaeffer","ppno":7812861313,"pcpadd":"830 Main St,","pcpcity":"Melrose","pcpstate":"MA","pcpzip":"02176","pcpcounty":"","pcpid":"","pcpname":"Hallmark Health Medical Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"104 SAVILLE ST","madd2":"","madd3":"","mcity":"SAUGUS","mstate":"MA","mzip":"01906","pcpfaxno":"","pcpnpi":1588984579,"currentgendcomment":"","pphycomment":"","uniqueid":68553300,"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":["M542","S134XXD","Z803","Z8042","J301","J3081","J3089","Z1211","K6389","K219","J4540","Z0000","M9903","M5416","M9904","M9901","G44209","M9902","J324","J342","J343","J3489","R55","R0981","Z1330","J4521","M5432","I959","N6325","J309","R42","Z743","Z01419","M5412","M47812","M7918","M950","J34829","Z1231","R92333","L236","J4520","Z8249","E876","R232","Z780","B351","R99","N83201","D259","N6342","R9230","K562","N854","R87610","G8929","R92343","R922","R92342","T7809XA"],"date":["2025-06-30","2024-08-13","2024-07-23","2024-07-23","2026-02-04","2025-07-18","2025-07-18","2024-08-26","2024-08-26","2024-08-26","2025-05-07","2026-01-12","2025-02-10","2025-02-10","2025-02-10","2025-02-03","2025-02-03","2025-02-10","2025-04-09","2025-07-07","2025-07-07","2025-04-09","2026-01-12","2025-07-07","2025-05-07","2025-05-07","2025-05-07","2026-01-12","2025-05-07","2026-01-12","2025-03-28","2025-03-28","2025-06-09","2025-06-30","2025-06-30","2025-06-30","2025-07-07","2025-07-07","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2025-10-14","2025-10-31","2025-10-29","2025-11-19","2026-01-12","2026-02-06","2024-06-04","2024-04-01","2024-06-25","2024-07-23","2024-08-26","2024-04-01","2024-04-10","2024-05-06","2024-05-30","2024-06-25","2024-06-25","2024-07-10"],"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":[["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","PREMPRO","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","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":""}]}]}