{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jacqueline Ferreira","gend":1,"currentgend":"","add":"303 TINKHAM ST","city":"NEW BEDFORD","state":"MA","zip":"02746","dob":"1990-08-07","age":"","mstatus":"","insh":"C0012608500","cliId":"","pno":7743281205,"cno":"","email":"","ename":"","eno":"","pphy":"Hannah R Stoops","ppno":5089731570,"pcpadd":"479 Swansea Mall Dr,","pcpcity":"Swansea","pcpstate":"MA","pcpzip":"02777","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"303 TINKHAM ST","madd2":"","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02746","pcpfaxno":"","pcpnpi":1396265724,"currentgendcomment":"","pphycomment":"","uniqueid":79449150,"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":["F902","F410","R99","L03011","L0291","F3181","Z113","R102","D259","N898","F319","L732","N939","D500","D709","Z124","Z1151","L709","Z0000","E0590","F411","H04123","L700","D485","L659","Z79620","Z8639","E063","E049","L02411","Z3009","Z3202","E663","Z6828","L820","E229","R030","F419","Z01419","Z23","R8789","Z79899","F909","Z0100","Z5181","L2089","Z1331","D649","N930"],"date":["2025-12-18","2025-12-18","2025-12-22","2024-10-03","2024-05-08","2025-12-18","2025-03-14","2024-06-26","2025-12-15","2024-12-08","2025-09-23","2025-11-17","2025-03-14","2025-12-16","2024-05-12","2025-12-15","2024-12-13","2025-09-23","2025-09-23","2025-12-16","2025-11-17","2024-02-27","2025-10-28","2024-04-26","2024-04-26","2024-11-09","2024-09-07","2024-09-07","2024-09-07","2024-05-08","2024-12-08","2024-12-08","2024-12-08","2024-12-08","2024-11-09","2025-09-23","2025-03-14","2024-05-12","2025-12-15","2025-04-29","2025-09-23","2025-10-28","2025-09-23","2025-03-18","2025-11-17","2025-07-05","2025-09-23","2025-09-23","2025-12-15"],"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":[["","","AZSTARYS","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","WINLEVI","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","SRONYX","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","VRAYLAR","","","Select","Select",""],["","","HUMIRA(CF) PEN CROHN'S-UC-HS","","","Select","Select",""],["","","HUMIRA(CF) PEN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","EC-NAPROXEN","","","Select","Select",""],["","","NORGESTIMATE-ETHINYL ESTRADIOL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","TAZAROTENE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","CABTREO","","","Select","Select",""],["","","COSENTYX UNOREADY PEN","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","ELLA","","","Select","Select",""],["","","BIMZELX AUTOINJECTOR","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","NORETHINDRONE","","","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":""}]}]}