{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christina A Mancebo-Torres","gend":1,"currentgend":"","add":"11 FAIRMOUNT ST","city":"NEW BEDFORD","state":"MA","zip":"02740","dob":"1986-11-19","age":"","mstatus":"","insh":"C0012191300","cliId":"","pno":"7744000897","cno":"","email":"","ename":"","eno":"","pphy":"Dillen J Bosgra","ppno":"5089732216","pcpadd":"500 Faunce Corner Rd, Ste 170","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"11 FAIRMOUNT ST","madd2":"APT 2","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02740","pcpfaxno":"","pcpnpi":"1669966115","currentgendcomment":"","pphycomment":"","uniqueid":"79107800","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":["R21","E66812","E6609","N920","Z6836","M25519","M25511","G8929","R102","R935","N924","R42","Z8673","M546","M542","G44209","S199XXA","S0990XA","M62838","J4521","U071","E6601","R110","Z7189","Z7182","Z0000","Z9851","G4700","F439","J4520","Z832","Z23","E611","N8003","T192XXA","R99"],"date":["2025-02-10","2025-11-03","2025-06-09","2025-06-09","2025-06-09","2025-02-25","2025-06-09","2025-06-09","2025-03-20","2025-04-19","2025-04-19","2026-02-06","2026-02-06","2025-12-30","2024-04-07","2024-04-04","2024-04-07","2024-04-07","2025-06-09","2024-08-06","2024-08-06","2024-10-03","2025-11-10","2025-03-04","2025-03-04","2025-02-10","2025-02-10","2025-02-10","2025-02-10","2025-02-10","2025-02-10","2025-02-10","2025-06-09","2025-04-19","2025-04-19","2025-06-30"],"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":[["","","TIZANIDINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","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":""}]}]}