{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Fabio A Pineda","gend":0,"currentgend":"","add":"68 HIGH ROCK ST APT 1","city":"LYNN","state":"MA","zip":"01902","dob":"1981-05-28","age":"","mstatus":"","insh":"C0013506800","cliId":"","pno":8576547003,"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":"","add3":"","madd1":"68 HIGH ROCK ST APT 1","madd2":"","madd3":"","mcity":"LYNN","mstate":"MA","mzip":"01902","pcpfaxno":"","pcpnpi":1942828983,"currentgendcomment":"","pphycomment":"","uniqueid":82361950,"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":["A419","K651","E8720","K219","F1010","I10","K7460","Z9049","K822","R188","T8143XA","K766","I8510","K7030","Z6830","E669","F1021","K5903","T402X5A","G4730","T8189XD","K668","R197","R194","E119","R110","Q649","Q559","R350","K0490","Z01810","R509","Z1152","Z6832","K811","R109","M546","M7910","R000","M79606","K429","K3189","Z09","R079","K838","K821","R161","K915","K810","R1011","J8402","I8511","Z6833","R1084","K5901","F321","Z7185","Z6834","Z23","Z8719","Z6835","F419","F32A","R399","Z8679","K2100","E66811","R82998","N400","Z119","Z0184","K7682","R99","K0889","Q441","K709","K660","K819"],"date":["2024-02-10","2024-10-23","2024-02-10","2025-03-04","2024-02-10","2025-01-16","2024-10-24","2025-09-25","2024-09-16","2024-10-21","2024-10-23","2024-10-23","2024-10-23","2025-10-22","2024-10-23","2024-10-23","2025-06-23","2024-10-23","2024-10-23","2024-10-23","2024-11-11","2024-11-11","2025-01-16","2025-01-16","2025-01-16","2025-04-23","2025-08-29","2025-08-29","2025-08-29","2024-04-20","2024-04-09","2024-10-23","2024-02-10","2024-10-10","2024-09-18","2025-04-23","2024-02-10","2024-10-23","2024-02-10","2024-02-10","2024-02-10","2024-02-10","2024-10-10","2024-10-21","2024-10-25","2024-10-24","2024-10-24","2024-10-25","2024-10-24","2024-10-23","2024-09-16","2025-12-22","2024-11-27","2025-03-31","2025-03-31","2025-03-31","2025-03-31","2025-03-04","2025-10-13","2025-06-23","2025-06-28","2025-06-23","2025-06-23","2025-09-25","2025-09-25","2025-09-25","2025-09-25","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2024-09-20","2025-08-30","2024-04-20","2024-09-16","2024-09-16","2024-09-16","2024-09-23"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NADOLOL","","","Select","Select",""],["","","LACTULOSE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","POLYETHYLENE GLYCOL 3350","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}