{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria Freitas","gend":1,"currentgend":"","add":"25 CRAPO ST","city":"TAUNTON","state":"MA","zip":"02780","dob":"1965-07-12","age":"","mstatus":"","insh":"C0028265000","cliId":"","pno":5088249078,"cno":"","email":"","ename":"","eno":"","pphy":"Irma Rasmussen","ppno":5088212500,"pcpadd":"1 Washington St,Ste 800","pcpcity":"Taunton","pcpstate":"MA","pcpzip":"02780","pcpcounty":"","pcpid":"","pcpname":"Revere Medical of Massachusetts, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 CRAPO ST","madd2":"","madd3":"","mcity":"TAUNTON","mstate":"MA","mzip":"02780","pcpfaxno":"","pcpnpi":1144287236,"currentgendcomment":"","pphycomment":"","uniqueid":136077650,"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":["N393","Z049","R635","E6601","K909","E669","I10","E785","Z6836","Z6834","E119","F330","J309","H109","R498","R0981","H5789","H16223","M069","H5052","Z6835","R7309","M9903","M9901","M9902","M9905","M9907","M47814","M5431","M5416","M62838","Z6837","M19011","M7541","M25511","M79604","M75111","M67813","M7501","Z1231","M75121","M7521","Z0000","Z1211","Z124","M75102","M7061"],"date":["2024-02-27","2024-02-27","2025-08-19","2024-02-23","2025-08-19","2025-08-19","2025-08-28","2025-08-28","2024-03-22","2024-05-24","2025-08-28","2025-08-28","2025-01-15","2024-05-13","2024-05-13","2024-05-13","2024-05-13","2024-07-29","2024-07-29","2024-07-29","2024-07-26","2025-08-19","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2024-09-20","2025-06-30","2025-05-03","2024-09-30","2024-09-30","2025-01-30","2025-06-30","2025-12-06","2025-04-28","2025-05-03","2025-10-06","2025-08-19","2025-04-28","2025-04-28","2025-07-17","2025-07-17"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","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":""}]}]}