{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lisa Fonseca","gend":1,"currentgend":"","add":"52 RIDGEWOOD DR","city":"TAUNTON","state":"MA","zip":"02780","dob":"1985-12-03","age":"","mstatus":"","insh":"C0019652100","cliId":"","pno":"7743220147","cno":"","email":"","ename":"","eno":"","pphy":"Kimberly  Curtis","ppno":"6173763000","pcpadd":"110 W Squantum St","pcpcity":"North Quincy","pcpstate":"MA","pcpzip":"02171","pcpcounty":"","pcpid":"","pcpname":"Manet Community Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"47 Harrison Ave","madd2":"A","madd3":"","mcity":"Taunton","mstate":"MA","mzip":"02780","pcpfaxno":"","pcpnpi":"1720866643","currentgendcomment":"","pphycomment":"","uniqueid":"97612000","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":["E039","E119","R99","J0100","R42","N9410","E669","Z7985","Z6836","H6691","Z30432","N946","Z124","I10","Z79899","R946","Z0000","Z6839","R059","R079","R102","Z30431","E6601","Z0100","Z6838","R519","H9201","Z7984","Z6835","R1030","R112","K5730","E785","R053","N939","Z975","Z1152","R1032","N83201","R9431"],"date":["2026-05-26","2026-05-14","2025-10-01","2025-12-11","2025-10-01","2025-09-11","2026-03-19","2026-03-19","2026-03-19","2025-10-01","2025-10-09","2026-04-22","2026-04-30","2025-04-30","2025-04-30","2024-09-19","2024-09-19","2025-06-12","2025-01-08","2025-04-30","2025-04-15","2025-01-08","2025-02-27","2025-02-10","2025-02-27","2025-04-29","2025-05-06","2025-05-29","2025-05-29","2025-04-15","2025-04-15","2025-04-15","2025-02-27","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-04-15","2025-04-15","2025-04-15"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}