{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Genesis D Flores Bautista","gend":1,"currentgend":"","add":"74 BRIDGETS PATH","city":"CENTERVILLE","state":"MA","zip":"02632","dob":"2004-08-02","age":"","mstatus":"","insh":"C0010755102","cliId":"","pno":7743688789,"cno":"","email":"","ename":"","eno":"","pphy":"Dawnnica K Eastman","ppno":5087718350,"pcpadd":"150 Ansel Hallet Rd,","pcpcity":"West Yarmouth","pcpstate":"MA","pcpzip":"02673","pcpcounty":"","pcpid":"","pcpname":"Medical Affiliates of Cape Cod, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"74 BRIDGETS PATH","madd2":"","madd3":"","mcity":"CENTERVILLE","mstate":"MA","mzip":"02632","pcpfaxno":"","pcpnpi":1376838672,"currentgendcomment":"","pphycomment":"","uniqueid":70223502,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F332","F4310","F339","Z113","Z0000","Z1330","N915","R300","Z3202","R350","S51812A","S51811A","X58XXXA","Y9289","Y9389","D7212","R000","R059","J029","R0981","N912","R7401","Z7689","T50905A","R99","F411","R45851","S61512A","S61511A","Z9151","Z79899"],"date":["2025-12-10","2025-12-10","2025-10-13","2024-04-10","2024-04-10","2024-04-10","2024-12-23","2025-07-17","2025-07-17","2025-07-17","2025-12-10","2025-12-10","2025-11-10","2025-11-10","2025-11-10","2025-11-25","2025-11-17","2025-11-17","2025-11-17","2025-11-17","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-12-11","2025-01-11","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2025-12-10"],"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":[["","","CEFUROXIME","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}