{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria Joana Rodrigues","gend":1,"currentgend":"","add":"54 GLENDALE ST","city":"BROCKTON","state":"MA","zip":"02302","dob":"1979-01-15","age":"","mstatus":"","insh":"C0019072900","cliId":"","pno":"7742253838","cno":"","email":"","ename":"","eno":"","pphy":"Shruti  Pathak","ppno":"5085596699","pcpadd":"63 Main St","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Brockton Neighborhood Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"54 GLENDALE ST","madd2":"","madd3":"","mcity":"BROCKTON","mstate":"MA","mzip":"02302","pcpfaxno":"","pcpnpi":"1124301304","currentgendcomment":"","pphycomment":"","uniqueid":"96379700","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":["R99","Z30011","Z309","J45909","Z3041","E66811","Z1231","U071","R748","R42","Z01419","R051","E669","Z6832","K219","Z880","Z7951","Z1211","K648","F411","E0590","M7910","E6609","Z6833","M5416","M5412","Z8639","Z6830","R5383","Z124","R142","R55","Z743","R7401","R7402","M5450","M542","M546","R945","Z713","Z7182","E661","D485","K068","I081","R059","Z6835","Z6836","L814","B079","L83","R7303","Z6834","L578","I361","R87610","R053","H52223","H16223","Z3202"],"date":["2026-03-25","2025-10-22","2025-12-29","2026-03-30","2026-03-06","2026-05-06","2026-05-12","2025-12-07","2026-03-30","2025-12-07","2026-01-07","2026-01-06","2026-01-06","2026-03-30","2026-01-06","2026-01-06","2026-01-06","2026-03-30","2026-03-26","2025-10-24","2025-11-21","2025-10-01","2025-11-21","2025-10-01","2026-04-16","2026-04-16","2025-11-29","2025-11-21","2025-12-07","2025-12-23","2025-12-01","2025-12-07","2025-12-07","2025-12-07","2025-12-07","2026-03-26","2026-04-16","2026-02-20","2026-03-11","2026-03-30","2026-03-30","2026-03-30","2024-10-22","2024-09-16","2024-08-02","2025-05-13","2024-11-12","2025-05-13","2024-10-22","2024-07-16","2024-10-22","2025-03-31","2025-02-17","2024-10-22","2024-08-02","2024-10-24","2024-11-12","2025-01-07","2025-01-07","2025-03-31"],"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":[["","","MUPIROCIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","NORETHINDRONE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","PHENTERMINE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","CRYSELLE","","","Select","Select",""],["","","FLULAVAL 2025-2026","","","Select","Select",""],["","","SLYND","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","TOPIRAMATE","","","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":""}]}]}