{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alissa Miranda","gend":1,"currentgend":"","add":"120 SOUTH ST E","city":"RAYNHAM","state":"MA","zip":"02767","dob":"1991-02-16","age":"","mstatus":"","insh":"C0018044900","cliId":"","pno":"5088578020","cno":"","email":"","ename":"","eno":"","pphy":"Juliana  Bahia Mazzafera","ppno":"5088948730","pcpadd":"31 Roche Brothers Way, Suite 210","pcpcity":"North Easton","pcpstate":"MA","pcpzip":"02356","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"120 SOUTH ST E","madd2":"","madd3":"","mcity":"RAYNHAM","mstate":"MA","mzip":"02767","pcpfaxno":"","pcpnpi":"1588152631","currentgendcomment":"","pphycomment":"","uniqueid":"94177600","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":["R99","Z0000","Z131","R7989","D649","R5383","E538","E785","E559","Z3493","Z3A34","Z3490","O164","Z370","Z3A38","O6981X0","O700","E119","E7800","I10","R748","Z23","Z3483","O80","Z379","O6982X0","O99214","O9902","D509","O9832","B009","L731","L720","L538","E66811","Z6833","L723","Z1331","Z139","Z8249","Z98890","H00014","Z391"],"date":["2026-03-30","2026-03-26","2026-03-26","2026-03-26","2026-03-26","2026-03-26","2026-03-26","2026-03-26","2026-03-26","2024-07-22","2024-07-22","2024-08-01","2024-08-17","2024-08-17","2024-08-17","2024-08-17","2024-08-17","2025-03-25","2025-03-25","2025-03-25","2025-05-02","2024-07-03","2024-07-17","2024-08-17","2024-08-17","2024-08-17","2024-08-17","2024-08-17","2024-08-17","2024-08-17","2024-08-17","2024-11-05","2025-02-25","2025-02-25","2025-03-25","2025-03-25","2025-03-25","2025-03-25","2025-03-25","2025-03-25","2025-03-25","2025-04-12","2024-08-01"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","PRENATAL VITAMINS","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","APRI","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","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":""}]}]}