{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan Engstrom","gend":1,"currentgend":"","add":"39 WEBSTER ST","city":"GLOUCESTER","state":"MA","zip":"01930","dob":"1969-09-15","age":"","mstatus":"","insh":"C0030850500","cliId":"","pno":9783800275,"cno":"","email":"","ename":"","eno":"","pphy":"James Maguire","ppno":9782811500,"pcpadd":"1 Blackburn Dr,","pcpcity":"Gloucester","pcpstate":"MA","pcpzip":"01930","pcpcounty":"","pcpid":"","pcpname":"Cape Ann Medical LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 1L","add3":"","madd1":"39 WEBSTER ST","madd2":"APT 1L","madd3":"","mcity":"GLOUCESTER","mstate":"MA","mzip":"01930","pcpfaxno":"","pcpnpi":1538111422,"currentgendcomment":"","pphycomment":"","uniqueid":140496100,"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","Z139","R0789","J45909","E785","M25511","R053","K219","G4700","G2581","M160","M797","K8020","H9193","D3502","E669","Z6841","Z8551","Z87891","Z79899","Z8661","Z7951","Z860100","Z7982","R079","M23203","M23204","R059","F411","T161XXA","I10","U071","M25559","M542","H04123","H2513","H43393","R0981","M25512","M25552","S0990XA","W19XXXA","K4090","F418","J4530","M9903","M5450","M9901","M47816","M47812","R234","E079","Z0000","Z87898","C679","M5416","M25561","M25761","H43813","H01003","E278","M25562","G8929","S83242A","M2242","X58XXXA","Z853","R92323","M1990","S83209A","R9431","D3500","M7531","J069","R058","K449","R99","M25551","R52"],"date":["2025-08-06","2025-08-06","2025-11-18","2025-11-16","2025-12-04","2025-11-16","2025-11-16","2026-01-29","2025-11-16","2025-11-16","2025-11-16","2025-11-18","2025-11-16","2025-11-16","2025-11-16","2025-11-16","2025-12-04","2025-11-16","2025-11-16","2025-11-16","2025-11-16","2025-11-16","2025-11-16","2025-11-16","2025-11-17","2025-12-02","2025-12-02","2026-01-29","2026-02-12","2024-05-16","2026-01-29","2024-08-08","2025-09-18","2025-02-27","2025-04-10","2025-04-10","2024-08-16","2024-08-04","2024-11-14","2025-04-03","2024-09-01","2024-09-26","2024-11-14","2025-12-04","2026-01-29","2025-02-27","2025-02-27","2025-02-27","2024-12-03","2024-12-03","2025-01-04","2025-01-28","2025-03-27","2025-11-18","2025-09-18","2025-04-03","2026-01-12","2025-04-24","2025-04-10","2025-04-10","2025-06-03","2026-01-12","2026-01-12","2025-06-25","2025-06-25","2025-06-25","2025-08-06","2025-08-06","2025-12-04","2025-09-18","2025-11-16","2025-12-04","2025-11-15","2026-01-05","2026-01-29","2026-01-29","2026-02-05","2025-04-03","2025-04-24"],"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":[["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUZONE 2025-2026","","","Select","Select",""],["","","GUAIFENESIN-CODEINE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}