{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amanda Pino-Gomez","gend":1,"currentgend":"","add":"839 LAKEVIEW AVE","city":"LOWELL","state":"MA","zip":"01850","dob":"1968-04-09","age":"","mstatus":"","insh":"C0031818300","cliId":"","pno":9789428234,"cno":"","email":"","ename":"","eno":"","pphy":"Porleng Hong","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":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"# 2","add3":"","madd1":"839 LAKEVIEW AVE","madd2":"# 2","madd3":"","mcity":"LOWELL","mstate":"MA","mzip":"01850","pcpfaxno":"","pcpnpi":1023413200,"currentgendcomment":"","pphycomment":"","uniqueid":142230050,"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":["R7303","R5383","M546","H9201","H019","H2513","H547","E119","E1165","R197","H04123","L853","H00021","H66001","Z0000","Z23","E559","Z98890","Z1231","R92323","Q141","R21","Z01818","H2511","H66003","H60331","K219","Z961","H2512","H524","N200","K760","M5450","Z09","R99","H40013"],"date":["2024-07-02","2024-07-02","2024-08-17","2024-08-17","2024-10-07","2025-06-11","2025-04-07","2026-02-24","2024-10-25","2024-10-25","2025-04-07","2024-12-04","2024-12-10","2024-12-10","2025-01-09","2025-01-09","2025-01-09","2025-01-09","2025-02-21","2025-02-21","2025-04-07","2025-05-15","2025-06-25","2025-07-08","2025-08-18","2025-10-21","2026-02-25","2025-11-04","2025-11-04","2025-11-04","2025-12-18","2025-12-18","2026-02-03","2026-02-02","2025-07-09","2024-07-24"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","NAPROXEN SODIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","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":""}]}]}