{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer L Souza","gend":1,"currentgend":"","add":"245 EUGENIA ST","city":"NEW BEDFORD","state":"MA","zip":"02745","dob":"1973-06-19","age":"","mstatus":"","insh":"C0020866200","cliId":"","pno":"7744002233","cno":"","email":"","ename":"","eno":"","pphy":"Christine  Will","ppno":"5089963991","pcpadd":"531 Faunce Corner Rd","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Lifespan Physician Group of Massachusetts, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"245 EUGENIA ST","madd2":"APT 2","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02745","pcpfaxno":"","pcpnpi":"1760458632","currentgendcomment":"","pphycomment":"","uniqueid":"99993900","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":["G4700","N951","R99","M79604","M25551","Z96643","Z471","M79651","R5383","R400","G4726","F458","M7712","H524","Z0000","Z780","E7849","E559","Z1331","F419","Z01419","Z124","R87810","R6882","Z90710","Z8041","R87610","Z1231","F4312","F411","F330","F5112","G4710","Z0100","R102","M25522","F39","N952","I10","F333","F329","F331","Z1389","Z139","F418","E785"],"date":["2026-03-24","2026-04-24","2026-05-01","2025-07-21","2025-07-21","2025-07-21","2025-07-21","2025-07-20","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2025-12-06","2025-10-27","2025-11-14","2026-01-02","2025-11-14","2025-11-14","2025-11-14","2025-11-14","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2026-03-19","2025-10-01","2025-05-03","2025-05-03","2025-05-03","2025-05-16","2024-10-21","2025-07-03","2025-10-03","2025-07-03","2025-04-15","2025-04-15","2024-08-15","2024-08-27","2024-11-09","2024-04-23","2024-03-04","2024-04-23","2024-03-04"],"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":[["","","DULOXETINE HCL","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","ESZOPICLONE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE ER","","","Select","Select",""],["","","BELSOMRA","","","Select","Select",""],["","","DAYVIGO","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ESTRADIOL (ONCE WEEKLY)","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","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":""}]}]}