{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nicole A Pacheco","gend":1,"currentgend":"","add":"150 OAKLAND ST","city":"FALL RIVER","state":"MA","zip":"02720","dob":"1985-08-03","age":"","mstatus":"","insh":"C0031874800","cliId":"","pno":"7743094790","cno":"","email":"","ename":"","eno":"","pphy":"Sara C Lundberg","ppno":"4016255552","pcpadd":"1800 Main Rd","pcpcity":"Tiverton","pcpstate":"RI","pcpzip":"02878","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"150 OAKLAND ST","madd2":"","madd3":"","mcity":"FALL RIVER","mstate":"MA","mzip":"02720","pcpfaxno":"","pcpnpi":"1144856063","currentgendcomment":"","pphycomment":"","uniqueid":"142340050","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":["K047","R99","E66812","Z0000","R5382","Z13220","Z6838","N921","M25561","M25562","G8929","E876","K429","N939","Z124","R87615","Z01810","I10","R9431","Z760","Z0100","F419","R519","E559","E785","D259","N854","N858","N946","N83201","Z87891","D251","B372","M170","R030","N840","Z3202","Z01818","S60211A","H0288A","H0288B","H5213"],"date":["2025-08-02","2026-05-15","2026-04-02","2026-03-13","2026-03-13","2026-03-13","2026-03-13","2026-03-20","2026-03-24","2026-03-24","2026-03-24","2026-03-25","2026-04-17","2026-04-06","2026-03-25","2026-03-25","2026-04-17","2026-04-21","2026-04-21","2025-09-01","2025-09-16","2026-04-06","2026-03-13","2026-03-13","2026-03-13","2026-03-20","2026-03-20","2026-03-20","2026-03-25","2026-03-30","2026-03-25","2026-03-30","2026-03-30","2026-03-24","2026-04-06","2026-04-06","2026-04-06","2026-04-17","2025-01-17","2024-09-10","2024-09-10","2024-09-10"],"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":[["","","ERYTHROMYCIN","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","NORETHINDRONE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","TELMISARTAN","","","Select","Select",""],["","","OXYCODONE 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":""}]}]}