{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria E Rodas Centeno","gend":1,"currentgend":"","add":"158 NORTH AVE","city":"HAVERHILL","state":"MA","zip":"01830","dob":"1973-01-07","age":"","mstatus":"","insh":"C0020742900","cliId":"","pno":"9783970346","cno":"","email":"","ename":"","eno":"","pphy":"Yohanna A Garcia Hernandez","ppno":"9783734400","pcpadd":"600 Primrose St, Ste 101","pcpcity":"Haverhill","pcpstate":"MA","pcpzip":"01830","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"158 NORTH AVE","madd2":"","madd3":"","mcity":"HAVERHILL","mstate":"MA","mzip":"01830","pcpfaxno":"","pcpnpi":"1508267345","currentgendcomment":"","pphycomment":"","uniqueid":"99832100","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66811","K2950","K3189","Z8719","Z809","E782","M79644","E559","Z1329","Z1159","Z130","R7303","K7689","M47816","Z6833","K269","K279","N951","Z6831","M19041","Z23","Z1331","Z1339","Z0001","N6322","M158","M21941","I8390","Z825","H524","R748","E6601","Z6837","Z6836","R7401","G5601","M65331","E66812","N6323","Z8711","Z8619","K6289","Z800","K601","N644","L309","M5450","M5442","R1032","G8929","Z6834","M51360","E669","L739","R634","M47817","N6002","R92323","Z98890","R92322","R99","G5602","M5412","M1712","M7052","M2242","D649","E785","R739","E079","G5603","M65332","N6325","M25561","M25562","M170","K2100","A048"],"date":["2026-02-26","2025-09-04","2025-09-05","2025-09-04","2025-09-04","2026-02-26","2025-12-30","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2025-08-04","2025-08-04","2025-09-04","2025-09-04","2025-11-06","2026-02-26","2025-12-30","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2026-02-26","2024-12-20","2025-01-06","2025-01-27","2025-01-06","2025-03-28","2025-02-27","2024-11-14","2025-01-22","2025-03-31","2025-02-27","2025-03-11","2025-03-11","2025-03-11","2025-03-11","2025-03-11","2025-03-28","2025-04-15","2025-04-24","2025-05-08","2025-05-21","2025-05-08","2025-05-08","2025-04-24","2025-05-22","2025-05-30","2025-05-21","2025-05-21","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-02-25","2024-10-21","2024-07-08","2024-08-08","2024-08-15","2024-08-08","2024-10-22","2024-10-22","2024-10-22","2024-10-22","2025-01-22","2025-01-22","2025-06-06","2024-07-23","2024-07-23","2024-10-21","2024-10-21","2024-10-21"],"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":[["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","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":""}]}]}