{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jamie Robbins","gend":0,"currentgend":"","add":"33 Marsh Hill Rd","city":"Brimfield","state":"MA","zip":"01010","dob":"1997-11-04","age":"","mstatus":"","insh":"C0028903400","cliId":"","pno":8608395855,"cno":"","email":"","ename":"","eno":"","pphy":"Iwona Prabucka-Davis","ppno":5087969211,"pcpadd":"489 Washington St,Ste 202","pcpcity":"Auburn","pcpstate":"MA","pcpzip":"01501","pcpcounty":"","pcpid":"","pcpname":"Auburn Primary Care and Aesthetics LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"33 Marsh Hill Rd","madd2":"","madd3":"","mcity":"Brimfield","mstate":"MA","mzip":"01010","pcpfaxno":"","pcpnpi":1518596642,"currentgendcomment":"","pphycomment":"","uniqueid":137664500,"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":["F332","F1090","F322","F411","M79621","M79631","M25511","S42401A","S42301A","S42341A","M25421","M7989","Z98890","S42401D","M24521","R99","S52209D","R200","R202","Z79899","F419","Z888","F17290","S42201A","G5631","S42102A","F1010"],"date":["2025-12-12","2025-12-12","2025-10-28","2025-12-12","2024-08-23","2024-08-23","2024-08-28","2025-03-03","2024-09-12","2024-08-22","2024-08-28","2024-08-28","2025-01-09","2025-01-09","2024-12-18","2026-02-26","2024-08-28","2024-09-05","2024-09-05","2024-09-05","2024-09-05","2024-09-05","2024-09-05","2024-11-25","2025-01-03","2025-03-03","2024-09-10"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","REXULTI","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","CLONIDINE HCL","","","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":""}]}]}