{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sharon L Fiske","gend":1,"currentgend":"","add":"57 N Main Street","city":"West Brookfield","state":"MA","zip":"01585","dob":"1978-03-16","age":"","mstatus":"","insh":"C0015404700","cliId":"","pno":7742629967,"cno":"","email":"","ename":"","eno":"","pphy":"James C Wilson","ppno":5088678977,"pcpadd":"46 N Main St,","pcpcity":"West Brookfield","pcpstate":"MA","pcpzip":"01585","pcpcounty":"","pcpid":"","pcpname":"West Brookfield Family Practice","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"1L","add3":"","madd1":"57 N Main Street","madd2":"1L","madd3":"","mcity":"West Brookfield","mstate":"MA","mzip":"01585","pcpfaxno":"","pcpnpi":1285622365,"currentgendcomment":"","pphycomment":"","uniqueid":88932350,"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":["R99","J339","J324","K219","E669","Z6835","M79671","Z1231","R059","J330","J320","J302","J309","J3089","R0981","L400","Z79899","M2550","R5383","Z13220","N926","Z0000","R053","G4733","E6601","Z111","E785","M7661","M7731","M7751","R92323","L821"],"date":["2025-12-30","2024-12-17","2025-10-24","2024-12-17","2024-12-17","2024-12-17","2025-10-10","2025-10-31","2024-05-03","2025-10-24","2024-08-05","2024-08-05","2024-05-29","2024-11-06","2024-08-29","2025-11-13","2025-11-13","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2025-05-30","2025-09-19","2025-09-19","2025-09-19","2025-06-22","2025-09-19","2025-07-11","2025-07-11","2025-10-10","2025-10-31","2025-11-13"],"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":[["","","GUAIFENESIN-CODEINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","BUDESONIDE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SKYRIZI PEN","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","MEDROXYPROGESTERONE ACETATE","","","Select","Select",""],["","","CODEINE-GUAIFENESIN","","","Select","Select",""],["","","BENZONATATE","","","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":""}]}]}