{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marcelino De Pina","gend":0,"currentgend":"","add":"19 OTIS ST","city":"BROCKTON","state":"MA","zip":"02302","dob":"1962-10-17","age":"","mstatus":"","insh":"C0031666600","cliId":"","pno":"7745171589","cno":"","email":"","ename":"","eno":"","pphy":"Shruti  Pathak","ppno":"5085596699","pcpadd":"63 Main St","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Brockton Neighborhood Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"19 OTIS ST","madd2":"APT 1","madd3":"","mcity":"BROCKTON","mstate":"MA","mzip":"02302","pcpfaxno":"","pcpnpi":"1124301304","currentgendcomment":"","pphycomment":"","uniqueid":"141791650","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Creoles & Pidgin (POR)"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4729","I429","I110","I5022","I4819","E1151","E6609","E7800","M479","Z7901","Z7984","Z87891","Z95810","I2510","R9439","I499","I739","I4820","I10","K625","K5790","K635","K649","D122","L209","M19012","R195","D125","I480","R002","R531","R42","R0989","I088","I318","I4891","K219","I4811","R55","I428","I509","I517","Z4889","R99","R7303","K648","K5730","K6289","E785","I119","I3481","I420","Z79899","R079","M25512","R9431","R0789","I70212","Z743","R21","E66811","Z6830","B349","Z713","Z7182","H524","H25813","Z7902","R519","R1084","Z1152","G8929","I5030","Z881","E781","M79602","M25562","L290","R110","Z0130"],"date":["2026-02-05","2026-03-18","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-18","2026-03-09","2026-03-09","2026-03-09","2026-03-18","2026-05-27","2026-04-29","2025-08-25","2025-08-25","2025-08-25","2025-08-25","2025-08-25","2025-09-12","2025-09-19","2025-08-25","2025-08-25","2025-11-03","2025-11-04","2025-11-03","2025-11-03","2025-11-03","2025-11-04","2025-11-04","2026-02-04","2025-11-19","2025-11-04","2025-11-03","2026-01-22","2026-01-22","2026-02-04","2026-02-04","2026-05-19","2026-04-20","2025-08-25","2025-08-25","2025-08-25","2025-08-25","2025-08-25","2025-08-25","2025-11-04","2025-11-04","2025-02-10","2025-01-04","2025-01-04","2025-01-04","2025-01-14","2025-01-03","2024-12-07","2024-12-07","2024-12-07","2025-02-10","2025-03-24","2025-03-24","2025-05-02","2025-05-02","2025-05-08","2024-07-03","2024-07-03","2025-02-10","2024-08-20","2025-01-04","2025-01-04","2024-07-01","2024-08-08","2024-08-08","2024-08-12","2024-11-01","2024-12-16"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","SUPREP","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE 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":""}]}]}