{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jacquelina Teixeira","gend":1,"currentgend":"","add":"154 DAVIS ST","city":"NEW BEDFORD","state":"MA","zip":"02746","dob":"1982-12-13","age":"","mstatus":"","insh":"C0007663903","cliId":"","pno":"6177948784","cno":"","email":"","ename":"","eno":"","pphy":"Christine  Will","ppno":"5089963991","pcpadd":"531 Faunce Corner Rd","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Lifespan Physician Group of Massachusetts, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"154 DAVIS ST","madd2":"APT 1","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02746","pcpfaxno":"","pcpnpi":"1760458632","currentgendcomment":"","pphycomment":"","uniqueid":"66973103","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","E669","L648","L301","M5416","M25562","L609","F4323","R110","R5383","R0981","Z1152","M7989","M79605","R202","D649","Z20822","D509","E538","M48062","E039","Z888","Z886","Z910110","Z79899","Z90710","L659","M064","B9689","B965","R0683","K219","K5909","R32","F418","M25569","Z8739","R102","R519","J302","L6689","Z0389","D485","R1020","Z1231","D2271","R7689","M5450","Z791","G8929","M9901","M25519","M9902","M9903","E559","M1712","B351","B353","Z6830"],"date":["2026-01-05","2026-05-14","2026-04-17","2025-11-25","2026-04-10","2026-05-15","2026-04-15","2026-05-26","2025-09-22","2026-01-09","2025-09-22","2025-09-22","2026-04-10","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2026-01-09","2026-01-09","2026-02-09","2026-02-09","2026-02-09","2026-02-09","2026-02-09","2026-05-14","2026-02-09","2026-04-15","2026-04-15","2025-11-25","2025-11-25","2026-05-14","2026-05-14","2026-05-14","2026-05-14","2026-05-14","2026-05-14","2026-05-14","2025-09-29","2026-05-14","2025-11-24","2025-11-06","2025-11-19","2025-11-25","2026-05-14","2025-11-05","2025-11-25","2026-01-06","2026-01-06","2026-01-06","2026-03-05","2026-01-17","2026-01-17","2026-01-17","2026-01-17","2026-03-19","2026-03-21","2026-04-15","2026-04-15","2026-05-14"],"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":[["","","AZITHROMYCIN","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","MINOXIDIL","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ECONAZOLE NITRATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","BUPROPION HCL SR","","","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":""}]}]}