{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Margaret Bryden","gend":1,"currentgend":"","add":"985 BERKSHIRE AVE","city":"INDIAN ORCH","state":"MA","zip":"01151","dob":"1975-11-25","age":"","mstatus":"","insh":"C0015521300","cliId":"","pno":4134596859,"cno":"","email":"","ename":"","eno":"","pphy":"Mark S Skalski","ppno":4137334101,"pcpadd":"305 Bicentennial Hwy,","pcpcity":"Springfield","pcpstate":"MA","pcpzip":"01118","pcpcounty":"","pcpid":"","pcpname":"Riverbend Medical Group,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 James St","madd2":"","madd3":"","mcity":"Feeding Hills","mstate":"MA","mzip":"01030","pcpfaxno":"","pcpnpi":1467676478,"currentgendcomment":"","pphycomment":"","uniqueid":89141850,"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":["I10","M542","R99","M5412","M7542","M7532","I83813","D1723","E6601","Z6828","F17210","Z86718","M7989","M5416","Z87891","I82432","Z7901","Z79899","Z1211","Z880","D179","M62838","M25512","G8929","L720","Z1231","Z0000","R2241","M50122","M4802","M50123","M5413","R591","J309","M5430","R590","R221","I824Y9","I82B11","M5126","M5481","M530","M5450","D6859","N390","R319","Z130","Z13220","Z131","Z1329","M79605","M799","I82539","M79602"],"date":["2025-10-24","2025-10-24","2025-10-31","2025-11-11","2024-09-24","2024-08-13","2024-06-27","2025-09-25","2024-08-27","2024-08-27","2025-10-20","2025-10-05","2024-09-26","2024-12-17","2024-08-13","2025-10-05","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2025-09-25","2025-10-20","2025-11-11","2025-10-24","2025-05-11","2025-08-19","2025-02-04","2024-06-24","2024-06-16","2024-06-16","2024-06-16","2024-08-13","2025-02-26","2024-11-09","2025-02-04","2024-09-24","2025-09-09","2024-12-24","2024-11-26","2024-09-12","2024-09-12","2024-09-12","2024-12-17","2025-05-20","2025-02-01","2025-02-01","2025-02-04","2025-02-04","2025-02-04","2025-02-04","2024-09-26","2025-10-05","2025-09-09","2025-10-24"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","GABAPENTIN","","","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":""}]}]}