{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eric L Da Trindade","gend":0,"currentgend":"","add":"230 Lantern Rd","city":"Revere","state":"MA","zip":"02151","dob":"1978-11-18","age":"","mstatus":"","insh":"C0015521901","cliId":"","pno":"7816563655","cno":"","email":"","ename":"","eno":"","pphy":"Boram  Han","ppno":"6175695800","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 21","add3":"","madd1":"230 Lantern Rd","madd2":"Apt 21","madd3":"","mcity":"Revere","mstate":"MA","mzip":"02151","pcpfaxno":"","pcpnpi":"1275948796","currentgendcomment":"","pphycomment":"","uniqueid":"89142151","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R519","G43009","R99","F40240","L309","B353","E039","G479","R42","R509","U071","J399","R000","K635","Z1211","G4709","F419","L853","I517","F4321","K5909","E611","R0683","Z20822","R070","K648","R799","K760","R5383","Z116","Z0000","H539","L308","M5442","B001","K219","B351","R21","E063","Z23","B352","L299"],"date":["2026-02-02","2026-02-04","2026-05-29","2025-08-26","2026-02-20","2026-03-18","2026-03-14","2026-02-04","2025-09-05","2025-09-25","2025-09-25","2025-09-25","2025-09-25","2025-10-17","2025-10-09","2026-02-04","2026-02-04","2026-02-20","2026-03-16","2025-11-19","2025-08-04","2025-08-27","2025-09-09","2025-09-25","2025-09-25","2025-10-09","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-02-12","2025-04-22","2025-03-05","2025-01-10","2025-03-05","2024-11-05","2025-01-10","2025-01-10","2025-01-10"],"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":[["","","KETOCONAZOLE","","","Select","Select",""],["","","AJOVY AUTOINJECTOR","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","EMGALITY PEN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CICLOPIROX","","","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":""}]}]}