{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kevin J Gonsalves","gend":0,"currentgend":"","add":"29 Cotton Candy Ln","city":"North Dartmouth","state":"MA","zip":"02747","dob":"1978-12-18","age":"","mstatus":"","insh":"C0017274901","cliId":"","pno":7745264618,"cno":"","email":"","ename":"","eno":"","pphy":"Patricia Tweedie","ppno":5086747779,"pcpadd":"289 Pleasant St,Ste 602","pcpcity":"Fall River","pcpstate":"MA","pcpzip":"02721","pcpcounty":"","pcpid":"","pcpname":"Prima Care, PC","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"29 Cotton Candy Ln","madd2":"","madd3":"","mcity":"North Dartmouth","mstate":"MA","mzip":"02747","pcpfaxno":"","pcpnpi":1639130651,"currentgendcomment":"","pphycomment":"","uniqueid":92898601,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N186","Z992","N2581","I10","D631","N185","D508","I770","W108XXA","S42121A","S42141A","S42201A","S32401A","S32591A","S46001A","N189","I129","I252","F17210","Z5329","S32501A","S42124A","S4291XA","S32592A","I214","Z87891","D649","I429","N184","I2510","I120","F17200","M79642","R799","S76119A","M25061","G8911","S8991XA","M25461","M25462","M25561","M25562","S76111A","S76112A","N250","I5022","R0609","S76101A","S76102A","Z0000","Z13220","E7800","Z7982","D62","M1990","M898X9","Z79899","Z885","Z760","R99","B999","E559","S42143A","M25511","S76111D","S76112D","S32810A","I2489","E213","E611","F40240","I160","F410","S301XXA","Z716","Z79891","S46311A","E782","I151","M79661","S32511A","S3722XA","R000","S299XXA","N261","Z043","M25521","I428","S43011A","S79911A","M25551","M79601","S129XXA","S42131A","R590","S32591D","S32401D","S42123A"],"date":["2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-28","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-28","2025-11-28","2025-11-12","2025-11-12","2025-04-02","2024-12-02","2025-06-15","2025-09-25","2024-11-04","2025-06-16","2025-06-16","2025-06-16","2024-10-29","2025-04-02","2024-12-11","2024-12-11","2024-10-31","2024-10-31","2024-10-31","2024-10-31","2024-01-11","2024-10-31","2024-10-31","2025-04-02","2025-06-18","2025-09-09","2025-03-25","2024-01-11","2024-01-11","2025-04-02","2025-04-02","2025-06-16","2025-06-16","2024-01-11","2024-01-11","2024-01-11","2025-06-16","2025-06-16","2025-11-25","2025-11-25","2024-05-06","2025-07-09","2025-11-25","2025-04-12","2025-09-01","2025-09-01","2025-06-18","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-04-02","2025-09-25","2025-06-15","2025-06-18","2025-06-15","2025-06-15","2025-06-16","2025-06-16","2025-06-16","2025-06-17","2025-09-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SEVELAMER CARBONATE","","","Select","Select",""],["","","XPHOZAH","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","VELPHORO","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NICOTINE PATCH","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","NALOXONE HCL","","","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":""}]}]}