{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria Brito","gend":1,"currentgend":"","add":"102 MARLBORO ST","city":"CHELSEA","state":"MA","zip":"02150","dob":"1967-06-22","age":"","mstatus":"","insh":"C0034187200","cliId":"","pno":7812197416,"cno":"","email":"","ename":"","eno":"","pphy":"Eileen Pierce","ppno":6175695800,"pcpadd":"20 Maverick Sq,","pcpcity":"East Boston","pcpstate":"MA","pcpzip":"02128","pcpcounty":"","pcpid":"","pcpname":"NeighborHealth Corporation","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 3","add3":"","madd1":"102 MARLBORO ST","madd2":"APT 3","madd3":"","mcity":"CHELSEA","mstate":"MA","mzip":"02150","pcpfaxno":"","pcpnpi":1518176817,"currentgendcomment":"","pphycomment":"","uniqueid":146619950,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Creoles & Pidgin (POR)"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2609","R079","R0602","M79671","M7731","M19071","M79651","M79661","R112","R1013","F4320","M722","I4729","R002","F411","R7303","R55","I2690","H8110","K219","I10","M25562","K5792","R1033","R110","I2693","I2720","J4530","R7989","R0789","J069","R059","B9789","M79604","Z86711","R0600","Z7901","M7751","R1110","I4720","Z23","F5102","Z91148","Z6836","Z1239","I2782","R109","R000","G43009","Z1211","M1712","K5732","K760","Z9049","R99"],"date":["2024-12-02","2025-03-01","2025-01-12","2025-01-15","2025-01-15","2025-01-15","2025-01-15","2025-01-15","2025-02-12","2025-02-12","2025-02-12","2025-01-21","2025-04-16","2025-04-16","2025-04-16","2025-04-17","2025-04-16","2025-04-16","2025-04-16","2025-04-16","2025-09-19","2025-07-21","2025-12-04","2025-12-04","2025-12-04","2025-03-03","2024-12-02","2025-04-08","2024-11-24","2024-11-14","2024-11-14","2024-11-14","2024-11-14","2025-01-12","2025-01-12","2025-01-12","2025-01-12","2025-01-15","2025-02-12","2025-07-28","2025-03-03","2025-04-08","2025-07-28","2025-04-08","2025-04-08","2025-04-18","2025-02-12","2025-02-12","2025-07-28","2025-07-28","2025-08-21","2025-12-04","2025-12-04","2025-12-04","2025-12-04"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}