{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Loiane P Dias","gend":1,"currentgend":"","add":"136 SCOFIELD DR","city":"STOUGHTON","state":"MA","zip":"02072","dob":"1990-02-03","age":"","mstatus":"","insh":"C0018350400","cliId":"","pno":6176314553,"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":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"136 SCOFIELD DR","madd2":"","madd3":"","mcity":"STOUGHTON","mstate":"MA","mzip":"02072","pcpfaxno":"","pcpnpi":1588152631,"currentgendcomment":"","pphycomment":"","uniqueid":94828000,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Portuguese"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","G43909","K219","R059","E559","E538","Z119","Z113","R946","N898","R1032","R9389","N6323","N6320","R5383","D649","R399","N939","Z021","E663","R4589","J029","L811","Z1331","J09X2","Z6827","Z793","Z0000","B351","F32A","Z6826","R1020","G4730"],"date":["2026-02-17","2026-02-26","2024-09-25","2025-02-05","2025-02-25","2025-02-25","2025-02-25","2025-11-13","2025-11-06","2025-11-13","2025-11-21","2025-11-21","2025-12-04","2025-12-04","2025-11-13","2025-11-13","2025-11-13","2026-01-30","2025-02-12","2025-11-06","2025-02-05","2024-07-16","2025-02-05","2025-02-12","2025-02-05","2025-09-16","2025-02-05","2025-02-12","2025-11-06","2025-09-16","2025-11-06","2025-11-13","2025-11-20"],"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":[["","","TRI-ESTARYLLA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","TOPIRAMATE","","","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":""}]}]}