{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kyslanie Rivera","gend":1,"currentgend":"","add":"18 AMES ST","city":"LOWELL","state":"MA","zip":"01852","dob":"2000-04-25","age":"","mstatus":"","insh":"C0029537400","cliId":"","pno":9786778988,"cno":"","email":"","ename":"","eno":"","pphy":"Hagar Moudakkire","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 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 AMES ST","madd2":"","madd3":"","mcity":"LOWELL","mstate":"MA","mzip":"01852","pcpfaxno":"","pcpnpi":1184314197,"currentgendcomment":"","pphycomment":"","uniqueid":138514550,"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":["L304","J4520","O99119","L0390","E282","N62","D75839","D508","Z98891","O99212","O34219","Z369","D696","O99210","Z6841","Z3A19","Z3A29","O99213","Z3A32","E669","Z3A33","O99113","Z3A34","Z3A35","Z3A36","Z3A37","Z3A38","O471","Z3A39","O34211","O480","Z370","Z3A40","O6640","O76","L03311","O9089","G8918","Z7982","L680","Z3046","J029","H65191","Z3490","Z3201","Z3480","Z3689","Z3A08","O35BXX0","Z23","Z131","Z1332","Z3A28","O0993","O4212","O9902","D649","T8189XA","L03116","Z392","Z0000","E6601","Z713","Z7182","Z391"],"date":["2024-08-12","2025-12-04","2025-07-08","2025-08-17","2026-01-13","2024-06-12","2025-08-03","2025-11-12","2025-07-26","2025-03-13","2025-08-03","2025-03-13","2025-07-08","2025-07-26","2026-01-13","2025-03-13","2025-05-16","2025-07-26","2025-06-06","2025-07-26","2025-06-14","2025-08-03","2025-06-21","2025-07-03","2025-07-05","2025-07-12","2025-07-19","2025-07-26","2025-07-26","2025-08-03","2025-08-03","2025-08-03","2025-08-03","2025-08-03","2025-08-03","2025-08-17","2025-08-08","2025-08-08","2025-08-08","2024-10-17","2024-10-16","2024-11-20","2024-11-20","2025-05-13","2024-12-26","2025-05-17","2024-12-26","2024-12-26","2025-03-13","2025-12-04","2025-05-13","2025-05-13","2025-05-13","2025-07-08","2025-08-03","2025-08-03","2025-08-03","2025-08-12","2025-08-16","2025-09-17","2026-01-06","2026-01-13","2026-01-13","2026-01-13","2025-12-04"],"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":[["","","NYSTATIN","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","ASPIRIN EC","","","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":""}]}]}