{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gisela Santiesteban Ruiz Toranzo","gend":1,"currentgend":"","add":"151 BELLEVUE RD","city":"LYNN","state":"MA","zip":"01904","dob":"1965-12-12","age":"","mstatus":"","insh":"C0030193700","cliId":"","pno":3512305039,"cno":"","email":"","ename":"","eno":"","pphy":"Clark Van Den Berghe","ppno":7815813900,"pcpadd":"269 Union St,","pcpcity":"Lynn","pcpstate":"MA","pcpzip":"01901","pcpcounty":"","pcpid":"","pcpname":"Lynn Community Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"151 BELLEVUE RD","madd2":"","madd3":"","mcity":"LYNN","mstate":"MA","mzip":"01904","pcpfaxno":"","pcpnpi":1053752675,"currentgendcomment":"","pphycomment":"","uniqueid":139333700,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T43291A","E8809","E8342","D72829","D538","R634","Z87891","Z881","Z880","Z720","Z23","Z0000","Z1231","Z139","S62324A","R079","R0602","S20211A","W0110XA","M79641","S62324D","Z1211","Z124","Z1212","R928","N6311","J188","J9601","J111","R918","R590","R000","R9431","A403","N179","J101","R7881","R6520","B953","J1100","Z20822","J189","R030","D75839","E871","D649","S62354A","R99","A4189","E440","B370","J1008","J154","Z603","Z681"],"date":["2026-01-03","2026-01-03","2026-01-03","2026-01-07","2026-01-03","2026-01-03","2026-01-03","2026-01-03","2026-01-03","2026-01-07","2025-04-10","2025-04-10","2025-07-29","2025-04-10","2025-06-11","2025-04-22","2025-04-23","2025-04-22","2025-04-22","2025-05-01","2025-06-11","2025-06-04","2025-06-04","2025-06-04","2025-09-03","2025-09-03","2026-01-07","2025-12-29","2025-12-27","2026-01-02","2025-12-27","2026-01-03","2026-01-03","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-27","2026-01-02","2026-01-02","2026-01-02","2026-01-07","2026-01-07","2026-01-07","2025-05-21","2026-01-03","2025-12-27","2025-12-27","2025-12-27","2025-12-27","2025-12-27","2025-12-27","2025-12-27"],"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":[["","","PRIORIX","","","Select","Select",""],["","","NICOTINE PATCH","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","NICOTINE LOZENGE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}