{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jarlyn J Martinez-Alcantara","gend":1,"currentgend":"","add":"36 POPLAR ST","city":"LAWRENCE","state":"MA","zip":"01841","dob":"1996-12-04","age":"","mstatus":"","insh":"C0021221000","cliId":"","pno":"9788283245","cno":"","email":"","ename":"","eno":"","pphy":"Tanya D Campus","ppno":"9786851770","pcpadd":"150 Park St","pcpcity":"Lawrence","pcpstate":"MA","pcpzip":"01841","pcpcounty":"","pcpid":"","pcpname":"Greater Lawrence Family Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"# 1","add3":"","madd1":"36 POPLAR ST","madd2":"# 1","madd3":"","mcity":"LAWRENCE","mstate":"MA","mzip":"01841","pcpfaxno":"","pcpnpi":"1932175049","currentgendcomment":"","pphycomment":"","uniqueid":"100556650","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":["R1020","R110","R1310","R252","Z3042","E109","N939","H04123","H52223","H35411","D259","R109","R1030","R053","Z9641","K219","R99","Z309","L239","Z0000","D649","Z23","Z113","K5900","Z794","M5459","E1165","Z0001","K047","D252","N946","O99019","Z3A00","R531","R002","Z9109","R0989","N944","Z124"],"date":["2026-01-21","2025-10-30","2025-07-29","2025-07-29","2026-04-24","2026-05-07","2025-10-24","2025-09-05","2025-09-05","2025-09-05","2025-10-30","2025-10-30","2025-10-30","2026-01-21","2026-05-07","2025-08-21","2025-09-12","2026-04-24","2025-05-12","2025-06-17","2025-06-27","2025-06-17","2025-06-27","2025-06-17","2024-09-27","2024-08-30","2024-09-24","2024-10-04","2024-10-08","2025-02-20","2025-04-30","2025-05-02","2025-05-02","2024-08-30","2024-10-11","2025-02-25","2024-12-20","2025-04-17","2025-04-17"],"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":[["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","GLUCAGON EMERGENCY KIT","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","FIASP","","","Select","Select",""],["","","ALCOHOL PREP PADS","","","Select","Select",""],["","","MEDROXYPROGESTERONE ACETATE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","HUMALOG","","","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":""}]}]}