{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cristina D Lopes-Dasilva","gend":1,"currentgend":"","add":"211 COLLETTE ST","city":"NEW BEDFORD","state":"MA","zip":"02746","dob":"1987-09-08","age":"","mstatus":"","insh":"C0015953600","cliId":"","pno":7746279622,"cno":"","email":"","ename":"","eno":"","pphy":"John K Terzian","ppno":5085831100,"pcpadd":"711 W Center St,","pcpcity":"West Bridgewater","pcpstate":"MA","pcpzip":"02379","pcpcounty":"","pcpid":"","pcpname":"Bridgewater Primary Care and Cardiology, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"211 COLLETTE ST","madd2":"","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02746","pcpfaxno":"","pcpnpi":1619963337,"currentgendcomment":"","pphycomment":"","uniqueid":89917300,"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":["N949","Z01419","N898","Z124","R9431","R079","R0600","R011","R0989","I459","E785","D509","K219","G4730","R5382","R5381","R87616","R0789","R5383","L299","M2559","E559","R7303","Z0000","Z131","E118","L509","M25551","M25552","R3129","M7989","R2242","Z139","Z13220","R635","Z136","Z1329","L03039","L301","R638","R99","Z6838","F419","M549","K2100","M1990","D649","Z86018","Z7982","Z791","R748","M25472","R300","J029","Z20822"],"date":["2024-05-21","2024-05-21","2024-05-21","2024-05-21","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2024-06-06","2025-12-08","2024-08-24","2024-06-06","2024-05-21","2025-08-25","2024-05-05","2025-11-09","2024-08-24","2025-12-08","2025-12-08","2025-11-09","2025-10-01","2025-12-08","2024-03-10","2024-06-05","2024-06-05","2025-04-15","2025-08-25","2025-08-25","2025-04-09","2025-04-09","2025-09-18","2025-11-12","2025-11-12","2024-11-12","2025-03-01","2025-12-08","2025-12-31","2025-11-17","2025-12-24","2024-02-06","2024-02-06","2024-02-06","2024-02-06","2024-02-06","2024-02-06","2024-02-06","2024-12-09","2025-08-25","2024-06-05","2024-05-05","2024-05-05"],"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":[["","","HYDROXYZINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ZEPBOUND","","","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":""}]}]}