{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Yolanda m Medeiros","gend":1,"currentgend":"","add":"76 PORTLAND ST","city":"NEW BEDFORD","state":"MA","zip":"02744","dob":"1982-03-04","age":"","mstatus":"","insh":"C0014509100","cliId":"","pno":7744888151,"cno":"","email":"","ename":"","eno":"","pphy":"Sally F Alexandre","ppno":5089731230,"pcpadd":"500 Faunce Corner Rd,Ste 160","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"76 PORTLAND ST","madd2":"","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02744","pcpfaxno":"","pcpnpi":1053388827,"currentgendcomment":"","pphycomment":"","uniqueid":87079600,"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":["D219","D259","R1030","K219","R109","K5900","R140","R197","H5711","H47391","H35371","G4452","R42","E559","Z823","R519","J329","N939","Z0000","Z800","J4540","N921","E66811","E6609","Z6830","Z1239","Z7182","Z23","J309","J342","Z1231","K5904","M67922","R300","R399","R1020","N920","Z90721","D225","Z1283","L720","L578","R220","J302","L989","L729","R1010","Z01419","Z124","L7211","R99","J4530","R0602","M25561","Z111","E782","D508","J45901","L811","L814"],"date":["2025-02-13","2026-02-05","2024-11-18","2025-11-19","2024-11-18","2026-02-02","2024-11-18","2024-11-18","2025-01-09","2025-01-09","2025-01-09","2025-02-11","2025-02-11","2025-04-08","2025-01-14","2025-02-03","2025-04-11","2025-02-13","2025-04-08","2025-06-02","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-11","2025-04-11","2025-05-23","2025-06-02","2025-06-25","2025-10-11","2025-10-11","2025-10-09","2025-10-09","2025-10-09","2025-10-15","2025-10-15","2026-02-06","2025-10-15","2025-11-19","2025-11-19","2025-12-18","2026-01-14","2026-02-02","2026-02-05","2026-02-05","2026-02-06","2026-02-23","2024-05-08","2024-05-08","2024-08-31","2024-10-10","2024-10-10","2026-02-02","2024-05-03","2024-07-10","2024-07-10"],"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":[["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","ETODOLAC ER","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","VENTOLIN HFA","","","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":""}]}]}