{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gilmar Fagundes","gend":0,"currentgend":"","add":"4 RAVENWOOD RD","city":"PEABODY","state":"MA","zip":"01960","dob":"1972-01-14","age":"","mstatus":"","insh":"C0018517200","cliId":"","pno":"9783981593","cno":"","email":"","ename":"","eno":"","pphy":"Dana A Mann","ppno":"9787742555","pcpadd":"147 S Main St","pcpcity":"Middleton","pcpstate":"MA","pcpzip":"01949","pcpcounty":"","pcpid":"","pcpname":"Middleton Family Medicine Urgent Care, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4 RAVENWOOD RD","madd2":"","madd3":"","mcity":"PEABODY","mstate":"MA","mzip":"01960","pcpfaxno":"","pcpnpi":"1679764161","currentgendcomment":"","pphycomment":"","uniqueid":"95241050","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Portuguese"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K2100","R99","M79642","M79641","M79672","M79671","M0579","M2550","R3129","R21","R7989","D485","Z0000","R052","R718","E785","Z1331","Z91018","Z6831","E538","Z8639","N200","E278","I700","M5450","K6389","K3189","K219","Z1211","K635","K648","K2289","K9041","Z23","E559","M069","T50905D","Z87442","J302","H11003","S62001A","M19041","X58XXXA","K900","Z8719","R778","Z79899"],"date":["2025-11-11","2026-05-25","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2025-11-21","2025-11-03","2025-11-21","2025-11-21","2025-10-27","2025-11-11","2025-11-15","2025-11-15","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-21","2025-11-21","2025-11-21","2025-12-12","2024-07-02","2024-07-02","2024-07-02","2024-07-02","2024-07-02","2024-07-02","2024-07-02","2024-08-13","2024-07-25","2024-06-26","2024-05-17","2024-05-17","2024-05-17","2024-05-17","2024-05-17","2024-05-22","2024-05-22","2024-05-22","2024-06-26","2024-05-31","2024-05-20","2024-06-26"],"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":[["","","METHOTREXATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FOLIC ACID","","","Select","Select",""],["","","CLONAZEPAM","","","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":""}]}]}