{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janelle Bretal","gend":1,"currentgend":"","add":"203 EUGENIA ST","city":"NEW BEDFORD","state":"MA","zip":"02745","dob":"1985-12-23","age":"","mstatus":"","insh":"C0021053600","cliId":"","pno":"7744170859","cno":"","email":"","ename":"","eno":"","pphy":"Valentia  DaCunha","ppno":"5089961800","pcpadd":"208 Mill Rd","pcpcity":"Fairhaven","pcpstate":"MA","pcpzip":"02719","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 3","add3":"","madd1":"203 EUGENIA ST","madd2":"APT 3","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02745","pcpfaxno":"","pcpnpi":"1073748893","currentgendcomment":"","pphycomment":"","uniqueid":"100306800","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":["R99","J4540","F530","E785","Z0000","Z23","E66813","I10","Z6841","Z713","Z7182","Z87891","E282","R0781","Z789","Z124","Z1151","Z113","M62838","M546","R0683","R5383","G4733","G4719","J45909","J441","R062","G4730","Z01419","Z7689","Z803","Z800","F411","E6601","K219"],"date":["2026-05-07","2026-05-07","2026-05-07","2026-03-03","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-01-21","2025-01-21","2025-04-29","2025-04-29","2025-04-29","2024-07-03","2024-07-03","2024-10-21","2024-10-21","2024-11-19","2024-10-21","2024-10-21","2024-10-21","2024-10-21","2024-11-30","2025-04-29","2025-04-29","2025-04-29","2025-04-29","2025-03-13","2024-07-25","2025-02-07"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PROPRANOLOL 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":""}]}]}