{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rosiana A Fontes","gend":1,"currentgend":"","add":"44 W PARK ST","city":"BROCKTON","state":"MA","zip":"02301","dob":"1995-06-04","age":"","mstatus":"","insh":"C0020530400","cliId":"","pno":"5083326706","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":"44 W PARK ST","madd2":"","madd3":"","mcity":"BROCKTON","mstate":"MA","mzip":"02301","pcpfaxno":"","pcpnpi":"1124301304","currentgendcomment":"","pphycomment":"","uniqueid":"99490250","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":["N939","N840","R7303","R748","M79671","E559","E66812","Z87898","Z713","Z6835","J181","Z113","E66811","Z6833","J101","R051","L03012","Z3202","M7731","Z30011","E6609","Z6834","R99","N938","J189","Z01810","R5383","D509","N921","Z0000","E6601","Z6837","N970","R9389","R000","I517","L700","R059","M25562","R739","N760","Z0130","Z7182","Z7689","R0683","N898","Z124"],"date":["2025-12-01","2026-01-14","2025-12-22","2025-12-22","2026-02-26","2025-12-22","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2025-10-20","2026-01-14","2026-04-17","2026-01-21","2026-01-14","2026-01-14","2026-02-07","2026-03-12","2026-02-26","2026-03-12","2026-04-17","2026-04-17","2026-02-07","2025-08-28","2025-10-20","2025-11-25","2025-07-18","2025-07-30","2025-07-30","2025-07-18","2025-08-12","2025-08-12","2025-08-15","2025-08-28","2025-10-20","2025-10-20","2025-11-18","2025-10-20","2025-01-15","2024-08-06","2024-11-27","2025-01-14","2024-11-26","2024-11-26","2024-11-26","2025-01-30","2025-01-30"],"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":[["","","WEGOVY","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MEDROXYPROGESTERONE ACETATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NIKKI","","","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":""}]}]}