{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amanda d Duncan","gend":1,"currentgend":"","add":"22 tremont street","city":"salem","state":"MA","zip":"01970","dob":"1982-11-08","age":"","mstatus":"","insh":"C0029835700","cliId":"","pno":6172021204,"cno":"","email":"","ename":"","eno":"","pphy":"Kristin E Darden","ppno":9787448388,"pcpadd":"47 Congress St,","pcpcity":"Salem","pcpstate":"MA","pcpzip":"01970","pcpcounty":"","pcpid":"","pcpname":"North Shore Community Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"apt 1r","add3":"","madd1":"22 TREMONT ST","madd2":"APT 1R","madd3":"","mcity":"SALEM","mstate":"MA","mzip":"01970","pcpfaxno":"","pcpnpi":1942278049,"currentgendcomment":"","pphycomment":"","uniqueid":138834850,"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","G43701","L680","N951","F988","J4541","J0190","J3489","Z1231","Z1239","R928","N6489","R1010","N6325","E669","Z1211","D123","K648","Z86010","Z6830","J3089","J302","E66811","F411","F902","R42","Z760","E6609","H65112","I10","H9209","G243","M542","H6993","N926","F418","R070","G43109","N946","N943","J029","R1013","M5416","Z021","K136","Z111","F900","R030","H04122","H1132","R112","R110","R519","Z789","J45909","Z0100","M9904","N809","N6009","L03313","M722","N6002","Z23","L858","J4520","F819","L700","I83813","T8149XA","L989","J4540","T781XXD","J069","R0602","R051","R9431"],"date":["2026-02-16","2024-12-20","2025-03-04","2025-12-08","2025-03-31","2025-06-14","2025-12-04","2026-02-09","2025-06-23","2024-04-17","2025-01-17","2025-01-17","2024-06-21","2024-07-09","2025-06-16","2024-09-10","2024-09-10","2024-09-10","2024-09-10","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2025-12-08","2024-12-16","2024-04-13","2024-04-13","2024-04-18","2024-04-22","2024-04-22","2024-04-22","2025-10-24","2025-07-24","2024-04-30","2024-04-30","2024-04-30","2024-06-03","2024-06-12","2024-06-12","2025-06-04","2024-06-11","2025-07-22","2025-07-22","2025-07-28","2025-08-15","2025-08-26","2025-09-30","2025-09-30","2026-01-08","2026-01-08","2026-01-29","2026-01-30","2026-01-30","2026-01-30","2025-05-20","2024-07-16","2025-04-04","2024-07-23","2024-07-12","2024-07-12","2025-04-04","2024-07-09","2025-01-17","2025-01-17","2025-06-19","2025-02-24","2025-02-24","2025-02-24","2025-03-21","2025-04-09","2025-06-03","2025-05-06","2025-05-20","2025-06-19","2025-05-19","2025-06-12"],"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":[["","","VENTOLIN HFA","","","Select","Select",""],["","","SLYND","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","NORETHINDRONE ACETATE","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","KARIVA","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","VIENVA","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","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":""}]}]}