{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Givaldo Maltarolo","gend":0,"currentgend":"","add":"14 PARK ST","city":"OXFORD","state":"MA","zip":"01540","dob":"1977-06-28","age":"","mstatus":"","insh":"C0032074500","cliId":"","pno":"9787601894","cno":"","email":"","ename":"","eno":"","pphy":"Krzysztof  Kacprzak","ppno":"5084610011","pcpadd":"72 Cudworth Rd","pcpcity":"Webster","pcpstate":"MA","pcpzip":"01570","pcpcounty":"","pcpid":"","pcpname":"Inter Med Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 PARK ST","madd2":"","madd3":"","mcity":"OXFORD","mstate":"MA","mzip":"01540","pcpfaxno":"","pcpnpi":"1952364523","currentgendcomment":"","pphycomment":"","uniqueid":"142582600","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":["J020","Z23","Z2981","Z114","Z113","Z206","Z7252","Z1212","D239","L820","L2989","L538","R222","M1712","M25562","G8929","M25561","H5203","Z0100","H52203","H524","R2231","R99","F1290","M25462","Z202","N476","L989","R300","Z0000","D492","Z0001","Z1389","K529","F419","R7989","N4889","C44311","R208","E559","E291","R5383","D519","Z205"],"date":["2025-12-02","2025-12-02","2026-04-20","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-03-03","2026-05-13","2026-04-24","2026-04-24","2026-02-26","2026-03-05","2026-03-05","2026-03-05","2026-03-05","2026-03-03","2026-05-17","2026-02-26","2026-02-26","2025-08-25","2024-11-14","2024-10-15","2024-11-14","2024-11-14","2024-11-14","2024-11-13","2024-11-13","2024-11-13","2024-11-13","2024-11-13","2024-11-14","2024-12-05","2025-01-06","2025-02-19","2025-02-19","2025-02-19","2025-02-19","2025-06-17"],"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":[["","","EMTRICITABINE-TENOFOVIR DISOP","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TESTOSTERONE CYPIONATE","","","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":""}]}]}