{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Domingas Duarte","gend":1,"currentgend":"","add":"530 Pleasant St","city":"Brockton","state":"MA","zip":"02301","dob":"1960-02-05","age":"","mstatus":"","insh":"C0013122300","cliId":"","pno":5089331477,"cno":"","email":"","ename":"","eno":"","pphy":"Elena R Cotulbea","ppno":5085596699,"pcpadd":"63 Main St,","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Brockton Neighborhood Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"3W","add3":"","madd1":"530 Pleasant St","madd2":"3W","madd3":"","mcity":"Brockton","mstate":"MA","mzip":"02301","pcpfaxno":"","pcpnpi":1376740985,"currentgendcomment":"","pphycomment":"","uniqueid":80101750,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Creoles & Pidgin (POR)"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","I10","E11649","E1165","J4540","M542","K1121","R140","R079","S61012A","I4891","E119","Z7901","Z23","F332","F411","R7309","R1013","Z794","K219","R739","E6609","Z6832","R42","K5903","Z743","S61019A","Z1211","E109","F32A","S61012D","Z4802","H5203","H25013","R040","N3090","E663","I4710","M62838","J029","Z713","Z7182","Z7689"],"date":["2025-12-23","2025-12-23","2024-11-07","2025-12-23","2025-06-24","2025-09-16","2025-02-10","2024-09-04","2024-06-13","2024-07-19","2024-07-19","2025-06-24","2024-07-19","2024-07-19","2025-06-24","2024-08-22","2024-03-26","2024-03-18","2024-09-04","2024-03-26","2024-11-07","2024-11-07","2024-11-07","2024-06-13","2024-11-07","2024-07-19","2024-07-19","2024-07-25","2024-07-25","2024-07-25","2024-07-30","2024-07-30","2025-06-24","2025-06-24","2024-07-10","2024-07-10","2025-07-14","2025-06-24","2025-09-16","2025-02-10","2025-02-10","2025-02-10","2025-10-28"],"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":[["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","SYNJARDY","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","ASPIRIN","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","VICTOZA 3-PAK","","","Select","Select",""],["","","UNILET LANCETS","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","PREVNAR 20","","","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":""}]}]}