{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carolina Rosa","gend":1,"currentgend":"","add":"15 SKINNER ST","city":"BROCKTON","state":"MA","zip":"02302","dob":"1977-03-02","age":"","mstatus":"","insh":"C0019643700","cliId":"","pno":"5085774936","cno":"","email":"","ename":"","eno":"","pphy":"Remya  Tharackal-Ravindran","ppno":"5088940400","pcpadd":"110 Liberty St, Ste 2B","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"15 SKINNER ST","madd2":"APT 2","madd3":"","mcity":"BROCKTON","mstate":"MA","mzip":"02302","pcpfaxno":"","pcpnpi":"1639476690","currentgendcomment":"","pphycomment":"","uniqueid":"97586700","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","R059","J387","M5416","B353","N950","Z973","Z8632","Z9049","Z8249","Z833","Z0000","M5450","D252","N840","D251","N926","Z1231","M542","M5432","J029","Z79899","R053","E0789","H9202","R070","J069","J329","N939","M899","M51369","M47816","M47814","M8588","D1809","M5116","M7918","R202","E039","R0981","R6889","J310","J342","N938","M546","Z01818","H8113","K219","R200","R0989","J392","J351","R413","U071","D259","N858","M5430","R42","N951","R232","E785","R52","R61","M5431","Z970"],"date":["2026-05-25","2025-12-30","2026-03-09","2026-04-24","2025-09-02","2025-09-02","2025-09-02","2025-09-02","2026-02-09","2026-02-09","2025-09-18","2026-03-18","2026-04-24","2025-10-28","2026-02-25","2025-11-21","2026-02-20","2025-12-08","2025-12-19","2026-01-27","2025-12-19","2025-12-30","2026-03-09","2025-12-04","2025-12-19","2026-03-25","2025-12-30","2025-12-30","2026-02-25","2026-04-29","2026-03-25","2026-03-25","2026-03-25","2026-04-22","2026-04-22","2025-09-18","2026-04-24","2026-03-18","2025-12-04","2026-04-13","2025-12-30","2026-03-09","2026-03-09","2026-02-25","2026-03-18","2026-02-13","2026-03-18","2026-04-13","2026-03-18","2026-04-13","2026-04-13","2026-03-25","2026-03-18","2024-07-15","2024-10-29","2024-11-01","2025-03-13","2025-03-13","2025-03-13","2025-03-13","2025-03-13","2024-07-15","2024-10-07","2025-03-13","2025-03-13"],"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":[["","","PAXLOVID","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","FAMOTIDINE","","","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":""}]}]}