{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carlos R Ixen Aju","gend":0,"currentgend":"","add":"28 ARLINGTON RD","city":"DEDHAM","state":"MA","zip":"02026","dob":"1972-04-16","age":"","mstatus":"","insh":"C0006345401","cliId":"","pno":"6173198810","cno":"","email":"","ename":"","eno":"","pphy":"Taylor  D'Elia","ppno":"6177830500","pcpadd":"495 Western Ave","pcpcity":"Brighton","pcpstate":"MA","pcpzip":"02135","pcpcounty":"","pcpid":"","pcpname":"Charles River Community Health, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 ARLINGTON RD","madd2":"","madd3":"","mcity":"DEDHAM","mstate":"MA","mzip":"02026","pcpfaxno":"","pcpnpi":"1346029287","currentgendcomment":"","pphycomment":"","uniqueid":"66123101","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","J4540","J4550","F5084","R1110","D126","J849","J8410","J679","R0789","Z0000","M25561","G8929","R918","J984","I2510","R0781","D860","Z0001","Z1331","Z1339","D128","M25571","E7800","H524","K2930","J45909","R053","R059","R12","K219","J989","J189","Z1152","I639","K521","G459"],"date":["2026-05-27","2025-11-13","2026-05-27","2025-10-14","2025-10-14","2025-10-14","2026-03-17","2026-03-17","2025-12-16","2026-01-12","2026-01-27","2026-03-17","2026-03-17","2026-01-02","2026-01-12","2026-01-12","2026-01-12","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2026-04-22","2024-07-08","2025-06-16","2024-10-23","2025-04-13","2024-07-17","2025-04-01","2024-12-10","2025-06-13","2025-04-13","2024-11-06","2025-04-01","2025-03-12"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","OFEV","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","POLYETHYLENE GLYCOL 3350","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","SODIUM CHLORIDE","","","Select","Select",""],["","","NUCALA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","NINTEDANIB ESYLATE","","","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":""}]}]}