{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jose Ramos","gend":0,"currentgend":"","add":"282 SAINT JOSEPH AVE","city":"FITCHBURG","state":"MA","zip":"01420","dob":"1965-01-01","age":"","mstatus":"","insh":"C0026789701","cliId":"","pno":9787296052,"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":"","add3":"","madd1":"282 SAINT JOSEPH AVE","madd2":"","madd3":"","mcity":"FITCHBURG","mstate":"MA","mzip":"01420","pcpfaxno":"","pcpnpi":1467427708,"currentgendcomment":"","pphycomment":"","uniqueid":112104201,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2111","Z87891","R918","R4182","J9601","Z95811","N170","R402432","R570","I4901","E66811","K7200","K567","E870","I2510","I517","A419","M62838","I2102","I469","M7989","J9859","J189","S2243XA","Z4682","J811","I509","Z452","Z4659","J9811","J90","I214","Z8674","R0602","S2243XD","M5450","E039","G4730","E785","I10","E7800","M549","G8929","Z79899","R002","G5622","G4733","M79642","J690","R99","R600","Z760","I252","R059","U071","Z0000","J849","K760","I77819","Z79891","J101","E02","Z122","I2584","R202","Z8739","Z98890","M25742","I2109","I462","K922","E8351","E8720","J384","I4720","R319","J45909","I255","N182","E038","R040","R030","Z6830","F17201","E669","I7120","M47814","I77810","R21","M79671","Z23","J111","G4719","Z6832","H9193","L819","Z6834"],"date":["2025-09-10","2025-05-14","2025-06-10","2025-06-10","2025-12-10","2025-12-10","2025-12-10","2025-09-10","2025-12-10","2025-09-10","2025-09-19","2025-09-10","2025-09-10","2025-12-10","2025-12-10","2025-08-10","2025-08-10","2025-07-10","2025-12-10","2025-07-10","2025-09-10","2025-09-10","2025-09-10","2025-09-10","2025-12-10","2025-12-10","2025-12-10","2025-10-10","2025-10-10","2025-10-10","2025-10-10","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2025-12-30","2025-12-21","2025-10-20","2025-04-10","2025-04-10","2025-07-07","2025-04-10","2025-04-10","2025-06-27","2025-11-25","2025-11-12","2025-12-25","2025-08-07","2025-11-20","2025-11-27","2025-05-07","2025-11-11","2025-10-11","2025-11-21","2025-11-24","2025-03-31","2024-04-30","2024-04-30","2024-04-30","2024-01-07","2024-01-12","2025-03-31","2025-05-14","2025-05-14","2025-09-19","2025-06-27","2025-06-27","2025-08-07","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-09-19","2024-03-29","2025-03-31","2025-03-31","2024-04-30","2024-04-30","2025-03-31","2024-06-26","2024-10-18","2025-09-26","2024-06-12","2025-02-25","2025-03-31","2025-03-31","2025-05-30","2025-09-19"],"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":[["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ASPIRIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PRASUGREL HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}