{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tiara L Monteiro","gend":1,"currentgend":"","add":"748 SHAWMUT AVE","city":"NEW BEDFORD","state":"MA","zip":"02746","dob":"1994-09-24","age":"","mstatus":"","insh":"C0016821600","cliId":"","pno":5085425280,"cno":"","email":"","ename":"","eno":"","pphy":"Christine Will","ppno":5089963991,"pcpadd":"531 Faunce Corner Rd,","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Lifespan Physician Group of Massachusetts, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"748 SHAWMUT AVE","madd2":"","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02746","pcpfaxno":"","pcpnpi":1760458632,"currentgendcomment":"","pphycomment":"","uniqueid":91732950,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F329","J45909","R99","Z391","F418","F3341","R55","T588X1A","O99512","Z3A20","Z3689","Z3490","O9902","O721","Z370","D649","Z3A39","O99345","F411","F32A","J309","Z8041","Z369","Z3201","O210","Z3401","Z3682","Z3A12","H6120","Z0000","Z1331","Z13220","Z1329","Z13228","Z6823","H6122","I951","O359XX0","O322XX0","Z3A22","I498","O26892","R519","Z77098","Z0373","Z0374","Z3A32","O80","R87612","Z124","Z392","Z309","Z7689","O6003","O26853","Z3A33","O4292","N898"],"date":["2025-07-31","2024-12-03","2025-08-24","2025-06-10","2025-07-29","2026-02-26","2025-01-08","2024-12-03","2024-12-03","2024-12-03","2025-03-08","2025-03-19","2025-04-20","2025-04-20","2025-04-21","2025-04-20","2025-04-21","2025-07-29","2025-11-18","2024-06-18","2024-06-18","2024-12-05","2025-06-09","2024-09-17","2024-09-17","2024-10-18","2024-10-15","2024-10-15","2024-12-06","2024-12-05","2024-12-05","2024-12-05","2024-12-05","2024-12-05","2024-12-05","2024-12-05","2024-12-19","2024-12-20","2024-12-20","2024-12-20","2024-12-27","2024-12-03","2024-12-03","2024-12-03","2025-02-27","2025-02-27","2025-02-27","2025-04-21","2025-08-20","2025-06-09","2025-06-09","2025-06-09","2025-05-12","2025-03-08","2025-03-08","2025-03-08","2025-04-21","2025-08-20"],"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":[["","","DIAZEPAM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","METRONIDAZOLE","","","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":""}]}]}