{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kaleigh C Ndawula","gend":1,"currentgend":"","add":"73 ALANA DR","city":"NORTHBRIDGE","state":"MA","zip":"01534","dob":"1995-07-21","age":"","mstatus":"","insh":"C0026741200","cliId":"","pno":7742870759,"cno":"","email":"","ename":"","eno":"","pphy":"Emma G Polimeni","ppno":8008532288,"pcpadd":"45 Cape Rd,","pcpcity":"Milford","pcpstate":"MA","pcpzip":"01757","pcpcounty":"","pcpid":"","pcpname":"Edward M. Kennedy Community Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 226","madd2":"","madd3":"","mcity":"NORTHBRIDGE","mstate":"MA","mzip":"01534","pcpfaxno":"","pcpnpi":1376282004,"currentgendcomment":"","pphycomment":"","uniqueid":112022150,"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":["F331","F332","F419","F429","I780","Z1152","F410","F10120","M7910","F32A","F422","G4700","Z30432","M7742","M79672","R45851","F23","Z743","R0602","F10920","R457","R000","R99","F321","Z881","Z882","Z79899"],"date":["2024-11-07","2025-12-06","2025-12-06","2025-11-02","2024-12-07","2024-09-06","2025-12-06","2025-12-07","2025-12-07","2025-12-07","2025-12-03","2024-10-24","2024-01-05","2024-07-05","2024-07-05","2024-09-06","2024-09-06","2024-09-06","2025-12-07","2025-12-07","2025-08-16","2025-08-16","2025-11-08","2024-09-06","2024-09-06","2024-09-06","2024-09-06"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TIVICAY","","","Select","Select",""],["","","EMTRICITABINE-TENOFOVIR DISOP","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ATOVAQUONE-PROGUANIL 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":""}]}]}