{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jorge Roa","gend":0,"currentgend":"","add":"6 BISHOP ST","city":"NATICK","state":"MA","zip":"01760","dob":"1957-09-11","age":"","mstatus":"","insh":"C0038224701","cliId":"","pno":"7747071477","cno":"","email":"","ename":"","eno":"","pphy":"Pablo I Hernandez Itriago","ppno":"5088521805","pcpadd":"19 Tacoma St","pcpcity":"Worcester","pcpstate":"MA","pcpzip":"01605","pcpcounty":"","pcpid":"","pcpname":"Edward M. Kennedy Community Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"6 BISHOP ST","madd2":"","madd3":"","mcity":"NATICK","mstate":"MA","mzip":"01760","pcpfaxno":"","pcpnpi":"1457362931","currentgendcomment":"","pphycomment":"","uniqueid":"152593551","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I5030","N184","N2581","G4733","R99","E782","I509","J45901","E1121","R801","I10","J159","D7210","I130","I5032","Z7902","E6601","E1122","I4510","I2510","E785","Z955","Z8673","Z6833","Z7982","Z7984","Z794","M1990","Z79899","Z7952","Z9049","Z91013","Z1152","R601","I129","I110","I444","I4519","E118","J4520","E1165","N1830","R9389","R0600","J4531","R0689","R059","J984","J45909","Z8701","Z23"],"date":["2026-02-02","2026-02-12","2026-02-12","2026-02-09","2026-05-26","2026-03-30","2026-03-30","2026-03-16","2026-02-10","2026-02-10","2026-02-02","2026-01-10","2026-01-10","2026-01-10","2026-02-02","2026-01-10","2026-01-10","2026-01-10","2026-02-02","2026-02-02","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-01-10","2026-02-10","2026-02-10","2025-07-23","2026-02-02","2025-07-23","2025-08-29","2026-01-05","2026-01-05","2026-01-05","2026-01-09","2026-01-09","2026-01-09","2026-01-09","2026-01-09","2026-01-09","2026-01-10","2026-01-27","2026-01-27"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","NUCALA","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","ASPIRIN","","","Select","Select",""],["","","LOKELMA","","","Select","Select",""],["","","TRUEPLUS LANCETS","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","BREO ELLIPTA","","","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":""}]}]}