{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Zurlay Rivera","gend":1,"currentgend":"","add":"77 WENTWORTH RD","city":"REVERE","state":"MA","zip":"02151","dob":"1969-07-27","age":"","mstatus":"","insh":"C0012357700","cliId":"","pno":6175135839,"cno":"","email":"","ename":"","eno":"","pphy":"Loulya Chahine","ppno":6175695800,"pcpadd":"20 Maverick Sq,","pcpcity":"East Boston","pcpstate":"MA","pcpzip":"02128","pcpcounty":"","pcpid":"","pcpname":"NeighborHealth Corporation","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"77 WENTWORTH RD","madd2":"","madd3":"","mcity":"REVERE","mstate":"MA","mzip":"02151","pcpfaxno":"","pcpnpi":1770003477,"currentgendcomment":"","pphycomment":"","uniqueid":79245400,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42","E876","I10","Z79899","I773","R0609","M25531","G5601","M654","E785","R200","N393","I83813","E7800","E669","Z6835","Z98890","I2510","G459","R079","R600","R55","R7401","K760","R739","H8110","Z6833","Z6832","R002","M79641","R202","R531","R0602","Z6834","Z111","Z23","E66811","R0683","R4589","H538","Z1211","Z1239","E66812","I7789","Z713","G4733","R99","Q2112"],"date":["2024-10-02","2024-09-30","2025-10-10","2025-08-22","2024-10-02","2025-08-15","2024-12-15","2024-12-14","2024-12-15","2025-10-10","2025-01-29","2025-08-22","2025-08-22","2025-08-22","2025-08-22","2025-08-22","2025-09-15","2025-10-10","2024-09-30","2024-09-29","2024-09-30","2024-09-29","2025-06-03","2025-06-03","2024-10-11","2024-10-11","2024-10-11","2024-09-20","2025-01-29","2025-01-29","2025-01-29","2024-09-29","2025-04-04","2025-04-04","2025-05-07","2025-06-03","2025-10-10","2025-06-03","2025-06-03","2025-06-03","2025-06-03","2025-07-07","2025-11-17","2025-10-10","2025-11-17","2025-11-14","2025-11-18","2024-05-08"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","LISINOPRIL","","","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":""}]}]}