{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mayra Fernandez Suarez","gend":1,"currentgend":"","add":"17 WHITTIER ST","city":"HAVERHILL","state":"MA","zip":"01830","dob":"1964-10-24","age":"","mstatus":"","insh":"C0038202700","cliId":"","pno":"9786206122","cno":"","email":"","ename":"","eno":"","pphy":"Deborah A DeAngelis","ppno":"9796860090","pcpadd":"73D Winthrop Ave","pcpcity":"Lawrence","pcpstate":"MA","pcpzip":"01843","pcpcounty":"","pcpid":"","pcpname":"Greater Lawrence Family Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"# 1","add3":"","madd1":"17 WHITTIER ST","madd2":"# 1","madd3":"","mcity":"HAVERHILL","mstate":"MA","mzip":"01830","pcpfaxno":"","pcpnpi":"1669882593","currentgendcomment":"","pphycomment":"","uniqueid":"152557600","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":["S1181XA","S01412A","S71011A","X991XXA","Y9289","S1193XA","S0993XA","S71131A","R4182","S299XXA","X58XXXA","Z4802","R99","Z227","F4323","S065XAA","S0990XA","N390","G928","I2489","D72829","E860","R7989","R319","R7612","R413","S1191XA","I10","Z8615","S0181XA","R930","I6200","R059","J9811","G9389","R9431","R9439","I214","R6889","S0990XS","G9340","V892XXS","R410","G44309","I6529","V892XXA","Z111","S0192XA","Y9259","S0183XA","J939","R600","M25751","M25752","S01442A","R064","E041","Z0389","J069","R070","R030","R0981","Z6823"],"date":["2026-04-23","2026-04-23","2026-04-23","2026-04-23","2026-04-23","2026-05-05","2026-04-21","2026-04-23","2026-04-21","2026-04-21","2026-04-21","2026-05-05","2025-12-29","2026-04-28","2026-05-15","2025-10-14","2025-09-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-26","2025-12-28","2025-12-26","2026-02-05","2026-02-20","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2025-09-28","2025-10-14","2025-12-27","2025-12-27","2025-12-26","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-28","2025-12-28","2025-12-28","2025-12-27","2025-09-28","2025-09-28","2025-09-28","2026-02-05","2026-02-28","2026-04-21","2026-04-23","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-22","2025-06-04","2025-06-04","2025-06-04","2025-06-04","2025-06-04"],"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":[["","","BENZONATATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","RIFAMPIN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","AMITRIPTYLINE 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":""}]}]}