{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lidia C Estrela","gend":1,"currentgend":"","add":"63 KAY ST","city":"SOMERSET","state":"MA","zip":"02726","dob":"1962-11-03","age":"","mstatus":"","insh":"C0031755700","cliId":"","pno":7745269248,"cno":"","email":"","ename":"","eno":"","pphy":"Linda M Paiva","ppno":5089737766,"pcpadd":"534 Prospect St,","pcpcity":"Fall River","pcpstate":"MA","pcpzip":"02720","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"63 KAY ST","madd2":"","madd3":"","mcity":"SOMERSET","mstate":"MA","mzip":"02726","pcpfaxno":"","pcpnpi":1619302023,"currentgendcomment":"","pphycomment":"","uniqueid":142043650,"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":["R002","R051","B001","Z0000","Z23","R7989","E890","M8580","E785","E559","M25512","M779","Z9009","R350","Z01419","Z1231","Z1211","Z13820","R99","Z98890","Z01812","D34","E063","K219","E042","Z780","E782","Z1159","Z124","Z1151","R300","F5101","E041","F419","F4321","Z803","M8588","H2513","D3132","K5909","R509","J0100"],"date":["2025-08-26","2025-08-26","2025-08-26","2025-09-29","2025-09-29","2025-11-10","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-12-16","2025-12-16","2025-12-16","2025-12-16","2025-12-16","2025-12-30","2026-02-05","2024-07-02","2024-07-30","2024-07-17","2025-03-17","2025-01-10","2024-11-26","2025-03-17","2025-03-10","2025-12-16","2025-12-16","2025-12-30","2024-06-10","2024-07-16","2024-09-09","2024-08-05","2024-09-09","2024-11-26","2025-03-12","2025-03-12","2025-03-17","2025-07-02","2025-07-02"],"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":[["","","CALCITRIOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}