{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dipika Patel","gend":1,"currentgend":"","add":"92 BEACON ST","city":"LAWRENCE","state":"MA","zip":"01843","dob":"1989-05-03","age":"","mstatus":"","insh":"C0024862901","cliId":"","pno":4047972357,"cno":"","email":"","ename":"","eno":"","pphy":"Mandy Kaur","ppno":9782690030,"pcpadd":"203 Turnpike St,Ste 300","pcpcity":"North Andover","pcpstate":"MA","pcpzip":"01845","pcpcounty":"","pcpid":"","pcpname":"Revere Medical of Massachusetts, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"APT 4","add3":"","madd1":"25 VICTOR ST","madd2":"APT 12","madd3":"","mcity":"HAVERHILL","mstate":"MA","mzip":"01832","pcpfaxno":"","pcpnpi":1730116328,"currentgendcomment":"","pphycomment":"","uniqueid":107937351,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J329","Z92241","J320","E559","B3731","Z3169","R99","S61412A","Q758","G96198","Z98890","J322","J324","G9782","M419","M4184","Q7649","M41114","G935","M5187","M48061","M4807","G950","M5134","M5031","M50321","M50322","M50323","H905","J370","J301","J342","J343","J3489","K219","F458","J302","J3081","J305","Z0000","R5383","J309","Q899","H11131","Q059","J328","R350","Q0700","L603","Z01419","Z124","L292","G9389","W268XXA","W010XXA","N939","Q514","N8301"],"date":["2025-03-02","2024-05-21","2025-07-28","2025-06-06","2025-05-06","2025-10-19","2025-07-29","2025-08-15","2024-04-26","2025-07-24","2025-08-10","2025-07-28","2024-05-16","2025-03-02","2025-07-22","2025-07-25","2025-07-25","2025-04-29","2025-07-25","2024-05-03","2024-05-03","2024-05-03","2025-07-28","2024-05-03","2024-05-03","2024-05-03","2024-05-03","2024-05-03","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2024-04-24","2024-04-24","2024-04-24","2024-12-09","2025-05-06","2024-09-19","2024-04-04","2024-02-10","2025-03-02","2025-03-24","2025-05-06","2025-05-06","2025-05-06","2025-07-22","2025-07-22","2025-07-24","2025-07-24","2025-08-15","2025-08-15","2025-10-15","2025-11-18","2025-11-18"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","BUDESONIDE","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","PRENATAL VITAMINS","","","Select","Select",""],["","","FOLIC ACID","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}