{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria D Victoria","gend":1,"currentgend":"","add":"77 Eugenia St","city":"New Bedford","state":"MA","zip":"02745","dob":"1957-11-22","age":"","mstatus":"","insh":"C0034373100","cliId":"","pno":"7743197049","cno":"","email":"","ename":"","eno":"","pphy":"Gloriane  Afonso","ppno":"5089963991","pcpadd":"531 Faunce Corner Rd","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Lifespan Physician Group of Massachusetts, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"77 Eugenia St","madd2":"","madd3":"","mcity":"New Bedford","mstate":"MA","mzip":"02745","pcpfaxno":"","pcpnpi":"1376525063","currentgendcomment":"","pphycomment":"","uniqueid":"146907050","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":["Z0000","N644","I2510","E782","I10","E1165","H548","M8580","E0590","E559","E1142","Z8673","R911","R0609","Z794","R071","E119","E785","R99","H90A31","H65491","H6993","H90A22","Z1211","Z860100","D122","D123","Z980","K219","E1151","E7800","R109","K635","R600","R5383","L648","R809","E041","L659","L853","M2141","M2142","M25572","B351","E1159","H2513","H25013","H25043","H43393","E113293","Z01419","R1030","Z124","Z780","M216X1","M216X2","H43811","R10A3","B0229","G479","G5603","G5622","B370","L603","L84","J984","H906","H9311","I872","I83893","I809","M2550","E1121","L0390","M2140","M25571","M67872","R29898","Z0001","Z1231","Z01411","Z1331","M859"],"date":["2026-04-27","2026-05-04","2026-04-27","2026-04-29","2026-05-06","2026-05-04","2026-04-27","2026-04-27","2026-04-27","2026-04-27","2026-04-27","2026-05-06","2026-05-04","2026-05-04","2026-05-04","2026-05-06","2026-05-06","2026-05-06","2026-05-23","2025-10-27","2025-10-27","2025-10-27","2025-10-27","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2026-02-03","2026-04-20","2025-11-06","2025-07-16","2025-11-06","2025-08-01","2025-08-01","2025-08-13","2025-12-08","2025-12-08","2025-07-28","2026-04-20","2025-08-25","2025-08-25","2025-11-10","2026-04-20","2025-11-10","2025-09-05","2025-09-05","2025-09-05","2025-11-14","2025-11-14","2025-10-24","2025-12-09","2025-10-24","2025-10-24","2025-11-10","2025-11-10","2025-11-14","2025-11-19","2025-12-04","2025-12-04","2026-03-04","2025-12-04","2026-02-16","2026-04-20","2026-04-20","2026-03-30","2025-06-26","2025-06-26","2025-02-14","2025-02-14","2025-02-14","2025-03-27","2025-04-12","2025-04-12","2025-06-13","2025-06-13","2025-03-21","2025-03-21","2025-04-14","2025-06-12","2025-04-14","2025-04-14","2025-04-14"],"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":[["","","PREGABALIN","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 PLUS SENSOR","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}