{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria E Camacho","gend":1,"currentgend":"","add":"620 SHAWMUT AVE","city":"NEW BEDFORD","state":"MA","zip":"02740","dob":"1961-08-29","age":"","mstatus":"","insh":"C0031242000","cliId":"","pno":"7742066044","cno":"","email":"","ename":"","eno":"","pphy":"Jordan C Gularek","ppno":"5089963991","pcpadd":"531 Faunce Corner Rd","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Lifespan Physician Group of Massachusetts, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"620 SHAWMUT AVE","madd2":"","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02740","pcpfaxno":"","pcpnpi":"1346571098","currentgendcomment":"","pphycomment":"","uniqueid":"141067500","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":["E785","Z760","I10","R99","Z13810","K2100","K449","K317","K2960","K7402","E7800","M810","K760","Z90710","Z79899","E559","K219","R739","E782","R7989","J301","E8342","Z862","M8580","L409","L719","H04123","H524","K7400","Z01818","K2080","K2970","M150","Z0389","Z1231","F419","B349","G4733","R945","M25512","M67814","M8588","Z1389","D509","Z0100","Z1331","Z789","R5382","G4730","Z0000","J302"],"date":["2026-03-17","2026-03-16","2026-04-07","2026-05-27","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2025-10-01","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2025-10-16","2025-10-16","2025-11-17","2025-11-17","2026-01-14","2026-01-14","2026-02-02","2026-03-18","2026-04-15","2024-07-01","2025-02-04","2025-02-27","2025-05-21","2024-11-05","2024-11-05","2024-10-02","2024-09-17","2025-05-21","2024-10-10","2025-05-21","2025-02-04","2025-02-27","2025-06-11","2025-05-21","2025-05-21"],"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",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","AZELASTINE 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":""}]}]}