{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wilda Moreau","gend":1,"currentgend":"","add":"44A BEAVER PARK RD","city":"FRAMINGHAM","state":"MA","zip":"01702","dob":"1981-03-09","age":"","mstatus":"","insh":"C0030136200","cliId":"","pno":"8574066099","cno":"","email":"","ename":"","eno":"","pphy":"Craig F Noronha","ppno":"6174145951","pcpadd":"801 Massachusetts Ave","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02118","pcpcounty":"","pcpid":"","pcpname":"Evans Medical Foundation, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"44A BEAVER PARK RD","madd2":"","madd3":"","mcity":"FRAMINGHAM","mstate":"MA","mzip":"01702","pcpfaxno":"","pcpnpi":"1881640084","currentgendcomment":"","pphycomment":"","uniqueid":"139222600","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Creoles & Pidgin (FRE)"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","L509","Z79899","I10","R7303","E559","R350","Z1231","K760","Z130","N8003","R310","L299","Z113","K30","L508","T7819XA","E7800","K219","K5900","K9049","E66811","Z23","N939","H35033","Z124","N952","R140","N858","M5451","M5416","M25561","E6609","Z6832","M5432","M25569","M5450","D251","L292","N926","S0990XA","R0789","E119","S39012A","S161XXA"],"date":["2026-01-12","2025-10-17","2025-10-17","2026-03-03","2025-12-23","2025-10-29","2025-10-22","2025-11-11","2025-11-24","2025-10-29","2026-04-01","2025-11-04","2026-03-03","2025-10-29","2025-10-22","2025-11-24","2025-11-04","2025-11-24","2025-11-24","2025-12-23","2025-11-24","2025-12-23","2025-12-23","2026-04-01","2025-08-19","2026-04-01","2026-04-01","2026-04-01","2026-04-07","2025-01-22","2024-12-04","2025-01-22","2024-12-31","2024-12-31","2024-08-05","2024-08-05","2024-11-22","2024-09-17","2024-09-17","2024-09-17","2024-11-22","2024-11-22","2024-11-22","2025-01-11","2025-01-11"],"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":[["","","NIFEDIPINE ER","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SLYND","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","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":""}]}]}