{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Menghok Ly","gend":0,"currentgend":"","add":"7 RALPH ST","city":"LOWELL","state":"MA","zip":"01851","dob":"1960-11-06","age":"","mstatus":"","insh":"C0022736900","cliId":"","pno":9782425798,"cno":"","email":"","ename":"","eno":"","pphy":"Alexandra C Sturgis","ppno":9789379700,"pcpadd":"161 Jackson St,","pcpcity":"Lowell","pcpstate":"MA","pcpzip":"01852","pcpcounty":"","pcpid":"","pcpname":"Lowell Community Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"349 CONCORD ST","madd2":"","madd3":"","mcity":"LOWELL","mstate":"MA","mzip":"01852","pcpfaxno":"","pcpnpi":1255007878,"currentgendcomment":"","pphycomment":"","uniqueid":104254800,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Khmer"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F331","R051","I129","E782","I10","E790","F515","M25512","F4323","F332","F411","R7401","Z0000","H1820","J302","E559","F5105","G8929","H52223","H5213","H524","H2513","H47093","R7303","Z1211","F419","F4312","R413","Z23","Z87828","Z6826","Z713","Z7182","M25811","M7531","M25511","M67813","M24111","M19011","M75111","M24811","R99"],"date":["2024-07-22","2024-07-22","2025-10-27","2025-10-27","2025-10-27","2025-10-27","2024-12-17","2025-10-27","2024-08-03","2024-08-04","2024-08-04","2024-07-22","2025-07-24","2024-07-22","2024-11-25","2025-07-24","2024-07-22","2024-07-22","2024-09-27","2024-09-27","2024-09-27","2024-09-27","2024-09-27","2024-11-25","2024-12-18","2024-12-17","2025-07-24","2024-12-17","2025-04-02","2025-04-02","2025-07-24","2025-07-24","2025-07-24","2025-07-24","2025-09-25","2025-08-14","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2024-04-15"],"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":[["","","BENZONATATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","PRAZOSIN 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":""}]}]}