{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sara Raposo","gend":1,"currentgend":"","add":"144 LIBERTY ST","city":"FALL RIVER","state":"MA","zip":"02724","dob":"1991-08-01","age":"","mstatus":"","insh":"C0033106900","cliId":"","pno":"7743223096","cno":"","email":"","ename":"","eno":"","pphy":"Manuela  Mendes","ppno":"5086791033","pcpadd":"289 Pleasant St, Ste 203","pcpcity":"Fall River","pcpstate":"MA","pcpzip":"02721","pcpcounty":"","pcpid":"","pcpname":"Prima Care, PC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"144 LIBERTY ST","madd2":"APT 1","madd3":"","mcity":"FALL RIVER","mstate":"MA","mzip":"02724","pcpfaxno":"","pcpnpi":"1912904988","currentgendcomment":"","pphycomment":"","uniqueid":"144724650","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":["L03221","L0211","K122","M6008","M272","L0201","K029","Z880","Z881","Z9884","Z09","B954","Z79899","L03811","Z792","K0889","R220","K047","H70012","A491","Z889","T3695XA","J208","R053","E559","Z903","Z0000","R059","J309","E663","K219","R221","R0982","E538","E509","Z23","Z13220","R799","R300","R8290","J0390","R0981","J029","J3489","R509","R040","E569","H6093","Z6832","E66811","H60501","R99","Z87891","K055","Z4889"],"date":["2024-11-07","2024-10-10","2024-11-07","2024-10-02","2024-12-10","2024-10-29","2024-10-02","2024-10-29","2024-10-02","2024-10-02","2024-10-10","2024-10-29","2025-11-11","2024-11-07","2024-11-25","2024-09-02","2024-09-01","2024-09-06","2024-10-01","2024-10-03","2024-10-03","2024-10-03","2025-11-11","2025-04-11","2025-11-11","2025-04-23","2025-12-29","2025-04-23","2026-01-07","2025-04-23","2025-04-23","2025-04-23","2026-01-07","2025-04-23","2025-04-23","2026-01-02","2025-11-11","2025-11-11","2025-12-30","2025-12-30","2026-01-21","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2026-01-21","2025-04-23","2024-09-02","2024-09-01","2024-09-16"],"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":[["","","NALOXONE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LINEZOLID","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","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":""}]}]}