{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Georgina Marte Nunez De Lopez","gend":1,"currentgend":"","add":"8 THISSELL ST","city":"METHUEN","state":"MA","zip":"01844","dob":"1972-08-15","age":"","mstatus":"","insh":"C0031898600","cliId":"","pno":"9787017518","cno":"","email":"","ename":"","eno":"","pphy":"Vidal  Primiterio","ppno":"9782581057","pcpadd":"25 Marston St, Apt 105","pcpcity":"Lawrence","pcpstate":"MA","pcpzip":"01841","pcpcounty":"","pcpid":"","pcpname":"Lawrence Health Solutions, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"# 2","add3":"","madd1":"8 THISSELL ST","madd2":"# 2","madd3":"","mcity":"METHUEN","mstate":"MA","mzip":"01844","pcpfaxno":"","pcpnpi":"1861472987","currentgendcomment":"","pphycomment":"","uniqueid":"142351900","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E559","R7303","E782","E7800","I10","R99","Z0000","E119","Z114","E785","E039","E539","K760","B1920","Z0001","Z01419","Z1231","Z1239","Z712","R92333"],"date":["2025-09-17","2026-04-20","2025-09-17","2025-09-17","2026-04-20","2026-05-01","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-08-05","2025-10-29","2025-05-22","2024-09-11","2025-01-09","2025-05-22"],"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":[["","","VITAMIN D2","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","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":""}]}]}