{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna Stebbins","gend":1,"currentgend":"","add":"17 GREENWOOD ST","city":"GARDNER","state":"MA","zip":"01440","dob":"1964-09-16","age":"","mstatus":"","insh":"C0022358700","cliId":"","pno":9788468550,"cno":"","email":"","ename":"","eno":"","pphy":"Jennifer Ryan","ppno":9786303862,"pcpadd":"57 City Hall Ave,","pcpcity":"Gardner","pcpstate":"MA","pcpzip":"01440","pcpcounty":"","pcpid":"","pcpname":"Gardner Family Medicine Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"APT 3","add3":"","madd1":"17 GREENWOOD ST","madd2":"APT 3","madd3":"","mcity":"GARDNER","mstate":"MA","mzip":"01440","pcpfaxno":"","pcpnpi":1467427708,"currentgendcomment":"","pphycomment":"","uniqueid":103638500,"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","Z0001","R928","R921","R92333","R292","G629","R2681","Z1231","L659","E038","M25551","M461","M1611","E782","K219","F331","G6289","Z1239","Z23","F1020","R2231","L989","M720","Z7689","R9082","M4802","M4312","M50223","M9961","J353","I781","Z789","R21","M533","I10","D104","R198","Z0101","H5203","H40053","R0981","R051","M47816"],"date":["2025-12-27","2025-06-03","2024-04-17","2024-04-17","2025-04-19","2025-12-02","2025-12-02","2025-12-02","2025-04-19","2025-02-06","2025-04-09","2025-10-28","2025-10-09","2025-10-28","2025-06-03","2025-06-03","2025-06-03","2025-06-03","2024-02-29","2024-07-03","2025-06-03","2024-06-20","2024-06-20","2024-10-07","2024-01-11","2024-12-13","2024-12-13","2024-12-13","2024-12-13","2024-12-13","2024-12-13","2025-06-03","2025-03-17","2025-04-30","2025-04-30","2025-04-09","2025-09-17","2025-09-30","2025-11-25","2025-11-25","2025-11-25","2025-01-12","2025-01-12","2025-10-28"],"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":[["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","FOLIC ACID","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","KETOCONAZOLE","","","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":""}]}]}