{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Zoila Ramos","gend":1,"currentgend":"","add":"53 ELM ST","city":"LYNN","state":"MA","zip":"01905","dob":"1982-03-01","age":"","mstatus":"","insh":"C0010403200","cliId":"","pno":"7813464191","cno":"","email":"","ename":"","eno":"","pphy":"Nicole M Calder","ppno":"7815813900","pcpadd":"269 Union St","pcpcity":"Lynn","pcpstate":"MA","pcpzip":"01901","pcpcounty":"","pcpid":"","pcpname":"Lynn Community Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 3","add3":"","madd1":"53 ELM ST","madd2":"APT 3","madd3":"","mcity":"LYNN","mstate":"MA","mzip":"01905","pcpfaxno":"","pcpnpi":"1407405160","currentgendcomment":"","pphycomment":"","uniqueid":"69887250","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":["M25511","R7611","F332","H10812","H906","Z9089","H6123","H903","N644","N6022","N6489","Z809","E559","H9071","T1491XA","R7612","E7841","Z0000","D75839","D72829","R928","F4312","Z23","F5104","H52223","H524","D251","R1013","R112","R197","R100","Z01818","Z139","Z1231","M5450","R99","N1330","R509","R471","R059","R102","R1032","M25512","Z90710","F323","F804","N938","F32A","Z803","B028","L0390","R232","N939","D259","D4959"],"date":["2025-09-16","2025-07-29","2026-02-19","2026-03-23","2025-10-22","2025-10-22","2025-10-22","2025-10-15","2025-12-29","2026-01-28","2026-05-06","2026-02-24","2025-07-14","2025-07-14","2026-02-19","2025-09-09","2025-12-23","2025-12-15","2026-02-02","2026-05-11","2026-01-28","2026-04-09","2026-02-02","2026-02-19","2026-03-12","2026-03-12","2024-10-30","2025-02-26","2025-02-26","2025-02-26","2025-02-26","2025-03-26","2025-03-26","2025-05-08","2024-07-31","2024-11-05","2024-07-05","2024-10-16","2024-09-11","2024-09-25","2024-10-16","2024-10-16","2024-10-16","2024-12-02","2024-11-04","2025-06-16","2024-10-03","2024-10-03","2024-07-11","2024-08-21","2024-08-21","2024-09-18","2024-10-03","2024-10-09","2024-10-03"],"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":[["","","IBUPROFEN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","POLYETHYLENE GLYCOL 3350","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ISONIAZID","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","NABUMETONE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUOROMETHOLONE","","","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":""}]}]}