{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jessica Demelo","gend":1,"currentgend":"","add":"70 SHARP ST","city":"DARTMOUTH","state":"MA","zip":"02747","dob":"1981-06-25","age":"","mstatus":"","insh":"C0027740000","cliId":"","pno":"7749308636","cno":"","email":"","ename":"","eno":"","pphy":"Efrain  Torres","ppno":"7742023090","pcpadd":"651 Orchard St, Ste 202A","pcpcity":"New Bedford","pcpstate":"MA","pcpzip":"02744","pcpcounty":"","pcpid":"","pcpname":"Geriatric Internal Medicine Specialists, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"70 SHARP ST","madd2":"","madd3":"","mcity":"DARTMOUTH","mstate":"MA","mzip":"02747","pcpfaxno":"","pcpnpi":"1003859265","currentgendcomment":"","pphycomment":"","uniqueid":"133979300","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":["N200","M92529","F419","G43909","G8929","F32A","E669","Z6830","J45909","I479","Z79899","N132","R051","Z466","Z87442","N898","R350","Z3141","Z124","F411","F331","Z5181","G4733","G4700","F5104","M1712","M1711","R399","G4730","R059","U071","J4550","E559","J3089","G43009","F329","Z0001","R10A2","K760","Z960","R10A0","R000","R1110","N201","N202","N1330","E6609","N2889","J029","J45901","Z01419","F319","M5489","M25561","R99","N135","Z8619","M2391","J101","R110","G479","M549"],"date":["2026-03-27","2025-11-08","2026-03-11","2026-05-01","2025-11-08","2025-11-08","2025-11-08","2025-11-08","2026-03-11","2025-11-08","2025-11-08","2025-12-19","2026-01-02","2025-11-19","2025-12-19","2026-01-16","2026-01-16","2026-01-22","2026-01-16","2026-04-01","2026-04-01","2025-12-22","2025-11-13","2026-03-11","2026-02-26","2026-04-22","2026-04-22","2025-07-25","2025-07-26","2025-09-03","2025-09-03","2026-02-26","2026-03-11","2026-03-11","2026-03-11","2025-10-16","2026-03-11","2025-11-04","2025-10-20","2025-11-08","2025-11-04","2025-11-04","2025-11-04","2025-11-07","2025-11-13","2025-11-13","2025-11-13","2025-12-19","2026-01-02","2026-01-02","2026-01-16","2025-12-22","2026-03-11","2026-03-11","2026-05-23","2025-10-28","2025-10-28","2025-02-05","2025-02-21","2025-03-20","2025-03-20","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":[["","","DAYVIGO","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","REXULTI","","","Select","Select",""],["","","AJOVY AUTOINJECTOR","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","GARDASIL 9","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","FASENRA PEN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}