{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raysa H Mena Morillo De Campusano","gend":1,"currentgend":"","add":"192 WASHINGTON ST","city":"LYNN","state":"MA","zip":"01902","dob":"1970-02-01","age":"","mstatus":"","insh":"C0024683200","cliId":"","pno":"7813539450","cno":"","email":"","ename":"","eno":"","pphy":"Stephanie N Quamo","ppno":"6175695800","pcpadd":"10 Gove St","pcpcity":"East Boston","pcpstate":"MA","pcpzip":"02128","pcpcounty":"","pcpid":"","pcpname":"NeighborHealth Corporation","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 304","add3":"","madd1":"192 WASHINGTON ST","madd2":"APT 304","madd3":"","mcity":"LYNN","mstate":"MA","mzip":"01902","pcpfaxno":"","pcpnpi":"1457339731","currentgendcomment":"","pphycomment":"","uniqueid":"107597900","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":["B351","R99","E1140","E1165","R4189","R519","D1724","H25813","H11823","H0288A","H0288B","E119","H5213","H52203","E785","R413","Z1389","M25552","R2242","M7062","G5602","R7989","R809","R590","Z114","Z1159","Z0000","Z1211","L603","Z1239","M549","K5900","Z20822","Z23","R2241","I10","K219","Z791","Z7984","Z79899","Z98890","Z01810","R002","E781","Z789","Z227","R5383","M898X7","M271","Z0001","E089","Z711","Z1231"],"date":["2025-07-05","2026-04-03","2026-05-15","2026-01-29","2025-07-02","2025-07-25","2025-11-17","2026-03-20","2026-03-20","2026-03-20","2026-03-20","2026-04-03","2026-03-20","2026-03-20","2026-04-03","2025-08-12","2025-09-05","2025-10-10","2026-04-03","2025-10-24","2025-10-24","2026-01-29","2026-01-29","2026-01-29","2026-04-03","2026-04-03","2026-04-03","2026-04-17","2026-04-03","2026-04-17","2026-04-03","2026-04-03","2026-04-03","2025-06-04","2024-08-27","2025-06-04","2024-08-23","2024-08-23","2024-08-23","2024-08-23","2024-10-22","2024-08-02","2025-06-09","2025-05-15","2025-05-15","2024-07-03","2024-09-03","2024-08-27","2024-08-23","2025-03-28","2025-03-28","2025-03-28","2025-04-09"],"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":[["","","TRULICITY","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","CICLOPIROX","","","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":""}]}]}