{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Megan Hughes","gend":1,"currentgend":"","add":"6 JORDAN LN","city":"MIDDLETON","state":"MA","zip":"01949","dob":"1988-01-31","age":"","mstatus":"","insh":"C0010886300","cliId":"","pno":5085273406,"cno":"","email":"","ename":"","eno":"","pphy":"Dana A Mann","ppno":9787742555,"pcpadd":"147 S Main St,","pcpcity":"Middleton","pcpstate":"MA","pcpzip":"01949","pcpcounty":"","pcpid":"","pcpname":"Middleton Family Medicine Urgent Care, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"UNIT B","add3":"","madd1":"6 JORDAN LN","madd2":"UNIT B","madd3":"","mcity":"MIDDLETON","mstate":"MA","mzip":"01949","pcpfaxno":"","pcpnpi":1679764161,"currentgendcomment":"","pphycomment":"","uniqueid":70377700,"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":["R87810","Z1152","J029","R059","Z9109","F418","G4700","R053","J45909","J0190","G43009","R99","G43909","N760","H6692","F4320","Z7689","Z20828","M25521","Z0000","Z13220","R946","Z124","Z1331","R87610","R875","R87619","Z8742","N859","K219","R519","Z87891","Z79899","R112","R109","H73899","G44219","M5481","M530","R399","F419","R7989","R3129"],"date":["2025-10-21","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2025-09-17","2025-12-11","2024-02-21","2024-02-21","2025-04-13","2025-09-16","2024-10-07","2025-03-31","2024-10-31","2025-04-13","2025-11-20","2024-02-21","2024-06-03","2024-08-26","2025-10-10","2025-10-10","2025-02-27","2025-03-10","2025-02-10","2024-02-10","2024-02-10","2024-10-31","2024-12-11","2024-12-11","2025-02-27","2025-02-27","2025-04-13","2025-02-27","2025-02-27","2025-02-27","2025-04-13","2025-05-19","2025-05-19","2025-05-19","2025-10-10","2025-02-10","2025-10-10","2025-10-13"],"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":[["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLURBIPROFEN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","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":""}]}]}