{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Guadalupe Reyes","gend":1,"currentgend":"","add":"78 NEWHALL ST","city":"LYNN","state":"MA","zip":"01902","dob":"1971-04-30","age":"","mstatus":"","insh":"C0024674200","cliId":"","pno":9786016233,"cno":"","email":"","ename":"","eno":"","pphy":"Anil K Dubey","ppno":9787451200,"pcpadd":"331 Highland Ave,","pcpcity":"Salem","pcpstate":"MA","pcpzip":"01970","pcpcounty":"","pcpid":"","pcpname":"North Shore Physicians Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"78 NEWHALL ST","madd2":"","madd3":"","mcity":"LYNN","mstate":"MA","mzip":"01902","pcpfaxno":"","pcpnpi":1528077666,"currentgendcomment":"","pphycomment":"","uniqueid":107580800,"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":["Z1231","M542","R52","B342","M5451","M5459","R109","M5450","M797","I7300","F419","L900","G8929","F32A","M549","M25511","M25512","G2581","D509","M4306","M4302","G4733","G4710","M47896","M47812","Z0000","E559","E538","G4730","M79629","Z23","M25519","M5441","R200","R5382","M546","G4719","U071","R079","R509","R0602","R001","R9431","G4700","G4709","Z01419","Z98890","Q600","Z9049","H43391","R635","L811","L810","L814","L304","M6740","L2089","R99"],"date":["2025-05-15","2025-07-01","2024-10-06","2024-07-30","2024-08-22","2025-02-13","2025-02-17","2025-06-01","2025-07-01","2025-04-28","2025-06-03","2025-04-28","2025-06-26","2025-12-16","2025-07-01","2025-07-01","2025-07-01","2025-04-29","2025-04-29","2024-03-13","2024-03-13","2025-12-04","2025-03-01","2024-03-20","2024-03-20","2024-02-04","2024-02-04","2024-02-04","2024-03-24","2024-06-05","2024-06-05","2024-06-05","2024-06-05","2024-06-05","2024-06-05","2024-11-06","2025-12-04","2024-07-30","2024-07-30","2024-07-30","2024-07-30","2024-07-30","2024-07-30","2025-03-19","2025-03-03","2025-03-27","2025-03-27","2025-02-17","2025-02-17","2025-11-07","2025-04-09","2025-11-09","2025-11-09","2025-11-09","2025-10-22","2025-10-22","2025-05-12","2025-12-16"],"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":[["","","ESTRADIOL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","TACROLIMUS","","","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":""}]}]}