{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sobeida M Guerrero","gend":1,"currentgend":"","add":"103 Tracy Avenue - #1","city":"Lynn","state":"MA","zip":"01902","dob":"1965-08-05","age":"","mstatus":"","insh":"C0004534100","cliId":"","pno":9784061890,"cno":"","email":"","ename":"","eno":"","pphy":"Ernesto Da Silva","ppno":7815933400,"pcpadd":"480 Lynnfield St,","pcpcity":"Lynn","pcpstate":"MA","pcpzip":"01904","pcpcounty":"","pcpid":"","pcpname":"North Shore Physicians Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"103 Tracy Avenue - #1","madd2":"","madd3":"","mcity":"Lynn","mstate":"MA","mzip":"01902","pcpfaxno":"","pcpnpi":1487600268,"currentgendcomment":"","pphycomment":"","uniqueid":63451850,"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":["Z510","D0511","Z0000","R059","I10","E039","F411","E876","R739","E559","R058","Z1211","E66811","E6609","Z6830","Z1231","R102","R300","R350","E781","R7303","E611","B354","L239","M5450","R920","R921","K760","M25559","R7611","C50911","R9431","R42","R5383","F419","R200","R202","H938X2","Z733","Z79899","Z01419","N6091","N6081","L905","L719","L219","D1801","L814","N952"],"date":["2024-12-31","2025-09-18","2025-11-03","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2025-06-27","2025-02-09","2025-02-09","2025-02-09","2024-09-05","2024-09-16","2024-09-16","2024-09-05","2024-09-05","2024-09-05","2024-07-06","2024-06-08","2024-08-13","2024-10-22","2024-09-16","2024-01-10","2024-10-10","2024-10-10","2024-10-10","2024-10-10","2024-10-10","2024-10-10","2024-10-10","2024-10-10","2024-10-10","2024-10-22","2024-01-10","2024-01-10","2024-01-10","2025-12-12","2025-12-12","2025-05-19","2025-05-19","2025-02-09"],"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":[["","","IRBESARTAN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TAMOXIFEN CITRATE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","MINOCYCLINE HCL","","","Select","Select",""],["","","SELENIUM SULFIDE","","","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":""}]}]}