{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dalila Lucien","gend":1,"currentgend":"","add":"11 ALMA ST","city":"LOWELL","state":"MA","zip":"01854","dob":"1997-08-11","age":"","mstatus":"","insh":"C0042657900","cliId":"","pno":"9788840147","cno":"","email":"","ename":"","eno":"","pphy":"Stephanie A Marble","ppno":"9789379700","pcpadd":"161 Jackson St","pcpcity":"Lowell","pcpstate":"MA","pcpzip":"01852","pcpcounty":"","pcpid":"","pcpname":"Lowell Community Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 ALMA ST","madd2":"","madd3":"","mcity":"LOWELL","mstate":"MA","mzip":"01854","pcpfaxno":"","pcpnpi":"1114693090","currentgendcomment":"","pphycomment":"","uniqueid":"159846850","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":["R99","E669","Z6835","K921","K219","K2950","K449","K648","J45909","G4730","E6601","Z01818","Z1321","E559","Z6834","M6284","R1310","G8929","G43909","M549","R1013","R110","Z7951","H40013","Z0101","R519","H547","K2970","R112","R079","R55","R0609","R002","E6609","J4520","K5900","Z9884","K760","K759","Z113"],"date":["2026-02-02","2026-03-27","2026-04-10","2026-02-10","2026-04-10","2026-04-10","2026-04-13","2026-02-10","2026-04-10","2026-02-10","2026-04-10","2026-03-27","2026-03-27","2026-03-27","2026-04-10","2026-03-27","2026-04-10","2026-04-10","2026-04-10","2026-04-10","2026-04-10","2026-04-10","2026-04-10","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-02-10","2026-02-10","2026-02-23","2026-02-23","2026-02-23","2026-02-23","2026-04-10","2026-02-23","2026-02-10","2026-04-13","2026-04-10","2026-04-10","2026-04-29"],"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":[["","","VITAMIN D2","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","URSODIOL","","","Select","Select",""],["","","ONDANSETRON ODT","","","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":""}]}]}