{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Renata F Alves Maciel","gend":1,"currentgend":"","add":"66 S BEDFORD ST","city":"WOBURN","state":"MA","zip":"01801","dob":"1989-02-21","age":"","mstatus":"","insh":"C0027235000","cliId":"","pno":8579910852,"cno":"","email":"","ename":"","eno":"","pphy":"Melissa Rowe","ppno":7813066101,"pcpadd":"170 Governors Ave,","pcpcity":"Medford","pcpstate":"MA","pcpzip":"02155","pcpcounty":"","pcpid":"","pcpname":"Hallmark Health Medical Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"66 S BEDFORD ST","madd2":"","madd3":"","mcity":"WOBURN","mstate":"MA","mzip":"01801","pcpfaxno":"","pcpnpi":1205282563,"currentgendcomment":"","pphycomment":"","uniqueid":131868250,"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":["O09521","Z3682","Z3A12","N912","O209","O4421","Z3A13","O23592","N898","Z3A16","O3510X0","O09522","Z3A15","Z3A19","O09511","Z3A21","O352XX0","O4690","Z3483","Z3A24","O4692","Z3A25","N841","O321XX0","O09523","O26892","R109","Z3A26","Z1332","Z3A27","Z3482","Z23","R7309","Z3A34","Z3A35","O368190","O365930","Z3A37","O34219","Z370","R079","M79604","M79605","R7989","R0602","J9811","O34211","O99891","Z148","D821","O99810","Z124","Z1151","Z30430","Z3202","Z391"],"date":["2024-04-24","2024-04-03","2024-04-03","2024-03-13","2024-06-06","2024-03-16","2024-03-16","2024-03-16","2024-03-16","2024-03-16","2024-03-13","2024-08-15","2024-03-28","2024-04-24","2024-02-28","2024-08-05","2024-08-05","2024-05-24","2024-05-24","2024-05-24","2024-06-06","2024-06-06","2024-06-06","2024-06-06","2024-12-06","2024-12-06","2024-12-06","2024-12-06","2024-09-19","2024-06-18","2024-06-18","2024-02-07","2024-05-07","2024-08-08","2024-08-15","2024-08-25","2024-08-25","2024-08-30","2024-08-30","2024-08-30","2024-03-09","2024-03-09","2024-03-09","2024-03-09","2024-03-09","2024-03-09","2024-08-30","2024-08-30","2024-08-30","2024-08-30","2024-08-30","2025-07-01","2024-10-18","2025-07-01","2025-07-01","2025-02-17"],"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":[["","","PROGESTERONE","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ASPIRIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}