{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suyapa Fuentes","gend":1,"currentgend":"","add":"33A LOTHROP ST","city":"BRIGHTON","state":"MA","zip":"02135","dob":"1977-09-07","age":"","mstatus":"","insh":"C0009702000","cliId":"","pno":"8572516985","cno":"","email":"","ename":"","eno":"","pphy":"Gabrielle  Gigliotti","ppno":"6177830500","pcpadd":"495 Western Ave","pcpcity":"Brighton","pcpstate":"MA","pcpzip":"02135","pcpcounty":"","pcpid":"","pcpname":"Charles River Community Health, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"33A LOTHROP ST","madd2":"","madd3":"","mcity":"BRIGHTON","mstate":"MA","mzip":"02135","pcpfaxno":"","pcpnpi":"1952063570","currentgendcomment":"","pphycomment":"","uniqueid":"69139300","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","E119","E781","E1165","Z09","K8590","E8720","E871","K861","E663","Z794","Z79899","Z6827","E1169","K8500","E8729","E1122","N189","I459","K8020","Z7984","Z1231","R928","N6489","D649","E8339","E8351","E876","F32A","Z0001","Z1331","R079","Z8719","K2950","R932","K8580","D72829","E785","K760","K8080","R933","R109","E162","R739","Z713","Z7182","K838","R1084","R112","K8510","R9431","E782","Z23","Z124","Z1211","R1110","K8309","R1030","N83202"],"date":["2026-04-14","2026-04-14","2026-02-27","2026-05-05","2026-05-04","2026-01-29","2025-10-25","2025-10-25","2026-01-29","2025-10-23","2026-04-14","2026-03-20","2025-10-23","2026-01-14","2026-02-02","2026-01-29","2026-01-29","2026-01-29","2026-01-29","2026-01-30","2026-04-14","2026-02-03","2026-03-20","2026-03-20","2025-10-25","2025-10-25","2025-10-25","2025-10-25","2025-10-25","2025-12-01","2025-12-01","2025-12-01","2025-12-05","2026-01-29","2026-01-29","2026-01-31","2026-01-29","2026-01-29","2026-01-29","2026-01-29","2026-01-29","2026-01-31","2026-02-04","2026-02-18","2026-01-14","2026-01-14","2026-01-30","2024-12-20","2024-12-20","2025-01-03","2025-01-21","2025-01-21","2024-10-14","2024-10-14","2024-10-14","2025-01-02","2025-01-03","2025-01-02","2025-01-02"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","EASY TOUCH ALCOHOL PREP PADS","","","Select","Select",""],["","","OMEGA-3 ACID ETHYL ESTERS","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","HUMALOG KWIKPEN U-100","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","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":""}]}]}