{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alenilce Numeriano","gend":1,"currentgend":"","add":"3 GROVE CIR","city":"E BRIDGEWTR","state":"MA","zip":"02333","dob":"1971-10-02","age":"","mstatus":"","insh":"C0016718201","cliId":"","pno":7817754911,"cno":"","email":"","ename":"","eno":"","pphy":"Juliana Bahia Mazzafera","ppno":5088948730,"pcpadd":"31 Roche Brothers Way,Suite 210","pcpcity":"North Easton","pcpstate":"MA","pcpzip":"02356","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 GROVE CIR","madd2":"","madd3":"","mcity":"E BRIDGEWTR","mstate":"MA","mzip":"02333","pcpfaxno":"","pcpnpi":1588152631,"currentgendcomment":"","pphycomment":"","uniqueid":91513501,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D696","Z124","R87616","Z780","R6882","R062","Z1231","R55","R110","R99","H109","J449","E559","R946","Z1211","D122","K640","N898","Z01419","Z1151","H5789","E663","Z87891","N951","N912","Z1331","Z6826","D120","Z6827","Z803","Z98890","Z9049","Z98891","Z833"],"date":["2025-09-17","2024-12-11","2024-12-11","2025-02-25","2025-02-24","2025-02-24","2024-09-17","2025-09-17","2025-09-17","2025-11-30","2024-03-29","2024-12-11","2024-12-11","2024-09-17","2024-10-16","2024-10-16","2024-10-16","2024-12-11","2024-12-11","2024-12-11","2024-03-29","2024-12-11","2024-12-11","2024-12-11","2024-09-17","2024-09-17","2024-09-17","2024-10-16","2024-12-11","2024-08-11","2024-08-11","2024-08-11","2024-08-11","2024-08-11"],"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":[["","","PROGESTERONE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COMBIPATCH","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","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":""}]}]}