{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Magna Almeida","gend":1,"currentgend":"","add":"63 Woodman St","city":"Lynn","state":"MA","zip":"01905","dob":"1975-07-16","age":"","mstatus":"","insh":"C0005833100","cliId":"","pno":7813464211,"cno":"","email":"","ename":"","eno":"","pphy":"Rigoberto Lopez Saldana","ppno":6175685800,"pcpadd":"10 Gove St,","pcpcity":"East Boston","pcpstate":"MA","pcpzip":"02128","pcpcounty":"","pcpid":"","pcpname":"NeighborHealth Corporation","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"apt # 2","add3":"","madd1":"63 Woodman St","madd2":"apt # 2","madd3":"","mcity":"Lynn","mstate":"MA","mzip":"01905","pcpfaxno":"","pcpnpi":1942828983,"currentgendcomment":"","pphycomment":"","uniqueid":65786250,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Portuguese"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z113","N6489","E7849","J4521","F321","S0512XA","R519","L989","N951","Z1211","J349","R1013","Z23","F418","B351","L700","L810","L905","D225","L814","L821","L818","L608","R197","N939","N858","R42","R231","Z0001","Z7185","Z119","Z13228","Z131","Z1331","Z1231","Z79899","D649","F5102","R350","R99","L819","R059","M25562","M5450","G8929","F330","F411","E782","Z1239","Z0000"],"date":["2024-07-31","2024-08-22","2025-08-09","2024-10-09","2025-08-01","2025-04-03","2025-04-03","2025-04-03","2025-10-22","2025-04-03","2025-03-17","2025-03-27","2025-03-26","2025-12-09","2025-04-24","2025-04-24","2025-04-24","2025-04-24","2025-04-24","2025-04-24","2025-04-24","2025-04-24","2025-04-24","2025-07-30","2025-11-09","2025-08-26","2025-08-26","2025-08-26","2025-09-09","2025-08-09","2025-08-09","2025-08-09","2025-08-09","2025-08-09","2025-09-22","2025-08-09","2025-12-09","2025-12-09","2025-12-11","2025-11-17","2024-07-31","2024-10-09","2024-12-07","2024-12-07","2024-12-07","2025-11-26","2025-10-03","2024-02-21","2024-01-02","2024-07-31"],"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":[["","","TRAZODONE HCL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRANEXAMIC ACID","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","LO LOESTRIN FE","","","Select","Select",""],["","","ESTRADIOL","","","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":""}]}]}