{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Betzaida M Munoz","gend":1,"currentgend":"","add":"27 SAGAMORE ST","city":"LYNN","state":"MA","zip":"01902","dob":"1985-01-15","age":"","mstatus":"","insh":"C0010040600","cliId":"","pno":"8572079569","cno":"","email":"","ename":"","eno":"","pphy":"Stephen J Simon","ppno":"7816412591","pcpadd":"10 Gove St","pcpcity":"East Boston","pcpstate":"MA","pcpzip":"02128","pcpcounty":"","pcpid":"","pcpname":"NeighborHealth Corporation","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"27 SAGAMORE ST","madd2":"APT 2","madd3":"","mcity":"LYNN","mstate":"MA","mzip":"01902","pcpfaxno":"","pcpnpi":"1568440857","currentgendcomment":"","pphycomment":"","uniqueid":"69472050","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","Z30011","Z79899","M059","M069","Z139","R2232","D849","Z23","M0579","A630","E559","G8929","Z9229","Z5112","N6022","N6082","R920","R87610","R87810","R87612","Z118","M25461","Z20822","Z3200","L639","Z119","Z1239"],"date":["2026-04-30","2026-05-30","2026-04-10","2026-05-07","2026-04-10","2025-09-10","2026-02-10","2026-04-10","2025-12-22","2026-02-27","2026-04-10","2026-02-27","2026-02-27","2026-02-27","2026-02-27","2026-04-21","2026-04-21","2026-04-17","2026-03-11","2026-03-11","2026-03-11","2026-04-22","2024-07-08","2024-07-08","2024-12-16","2025-03-25","2024-12-16","2025-03-25"],"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":[["","","FOLIC ACID","","","Select","Select",""],["","","ACTEMRA ACTPEN","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","AVIANE","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ORENCIA CLICKJECT","","","Select","Select",""],["","","XELJANZ XR","","","Select","Select",""],["","","VIENVA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","IMIQUIMOD","","","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":""}]}]}