{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jaclyn D Souza","gend":1,"currentgend":"","add":"272 SAVOIE ST","city":"FALL RIVER","state":"MA","zip":"02723","dob":"1991-12-07","age":"","mstatus":"","insh":"C0018534600","cliId":"","pno":"7743052892","cno":"","email":"","ename":"","eno":"","pphy":"Babak  Dehyimpanah","ppno":"5082355445","pcpadd":"203 Plymouth Ave, Ste 701","pcpcity":"Fall River","pcpstate":"MA","pcpzip":"02721","pcpcounty":"","pcpid":"","pcpname":"Prima Care, PC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"272 SAVOIE ST","madd2":"","madd3":"","mcity":"FALL RIVER","mstate":"MA","mzip":"02723","pcpfaxno":"","pcpnpi":"1518298918","currentgendcomment":"","pphycomment":"","uniqueid":"95280150","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":["R350","Z113","N898","Z202","Z1159","Z20828","K50819","Z0101","L700","L810","Z0000","M898X2","A6000","Z189","Z1331","M79641","S60551A","N390","R99","R109","R8290","K5090","L989","E282","M795","Z0389","Z13220","Z131","K50813","Z3041"],"date":["2025-12-19","2025-12-31","2025-12-19","2025-12-31","2025-12-31","2025-12-31","2026-03-10","2026-03-25","2026-05-31","2026-04-01","2026-04-13","2026-04-23","2026-05-30","2026-04-23","2026-04-13","2026-04-23","2026-05-11","2025-08-08","2026-04-22","2025-08-09","2025-08-09","2025-12-12","2025-02-26","2025-03-08","2024-11-13","2024-11-13","2025-04-10","2025-04-10","2025-04-10","2025-04-10"],"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":[["","","STELARA","","","Select","Select",""],["","","TRI-ESTARYLLA","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","STEQEYMA","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","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":""}]}]}