{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susana Brito Vasquez","gend":1,"currentgend":"","add":"176 PARK ST","city":"LAWRENCE","state":"MA","zip":"01841","dob":"1967-07-15","age":"","mstatus":"","insh":"C0021035500","cliId":"","pno":"9786013340","cno":"","email":"","ename":"","eno":"","pphy":"Tito  Joaquin","ppno":"9785578800","pcpadd":"500 Merrimack St","pcpcity":"Lawrence","pcpstate":"MA","pcpzip":"01843","pcpcounty":"","pcpid":"","pcpname":"Partners Community Physicians Organization Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"# 1","add3":"","madd1":"176 PARK ST","madd2":"# 1","madd3":"","mcity":"LAWRENCE","mstate":"MA","mzip":"01841","pcpfaxno":"","pcpnpi":"1164983201","currentgendcomment":"","pphycomment":"","uniqueid":"100242200","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":["R071","I10","R519","E119","R7401","R110","Z79899","R109","J069","N950","R102","N840","H40023","H2513","H11153","G8918","N939","R030","R5383","M25511","R079","R0600","R42","Z0389","R0789","Z23","R140","R143","D164","R99","K219","H1033","Z880","Z886"],"date":["2026-04-23","2026-04-23","2026-04-23","2026-04-27","2026-04-23","2026-04-23","2026-04-23","2025-07-16","2025-07-16","2026-04-10","2025-08-27","2026-04-10","2026-02-27","2026-02-27","2026-02-27","2026-04-02","2026-04-08","2026-04-02","2026-04-02","2026-04-16","2026-04-23","2026-04-21","2026-04-23","2026-04-23","2026-04-21","2026-04-27","2026-04-27","2026-04-27","2026-04-27","2025-07-16","2026-04-22","2026-05-22","2026-03-27","2026-03-27"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TOBRAMYCIN","","","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":""}]}]}