{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nirda Romero","gend":1,"currentgend":"","add":"23 SAINT CYPRIANS PL","city":"ROXBURY","state":"MA","zip":"02120","dob":"1969-08-12","age":"","mstatus":"","insh":"C0008732800","cliId":"","pno":"8573341739","cno":"","email":"","ename":"","eno":"","pphy":"Jeffrey R Schapiro","ppno":"7817704064","pcpadd":"1180 Beacon St, Ste 6B","pcpcity":"Brookline","pcpstate":"MA","pcpzip":"02446","pcpcounty":"","pcpid":"","pcpname":"Holtzman Medical Group, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 3","add3":"","madd1":"23 SAINT CYPRIANS PL","madd2":"APT 3","madd3":"","mcity":"ROXBURY","mstate":"MA","mzip":"02120","pcpfaxno":"","pcpnpi":"1760444129","currentgendcomment":"","pphycomment":"","uniqueid":"68178100","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":["R99","K8010","I10","J45909","Z7951","E785","E119","Z79899","R600","R1013","R1011","R10A1","R197","R110","Z113","E559","Z0000","Z1159","R1084","K8020","R112","R519","I440","D72829","Z8679","K810","Z1211","Z1231","Z2911","E6609","Z6833","Z09","Z029","Z9049","H11003","H5203","H524","R899","K760","H11153","R21","E782"],"date":["2026-05-19","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-03-28","2026-02-25","2026-04-29","2026-04-29","2026-04-29","2026-04-29","2026-04-29","2026-04-29","2026-02-27","2026-02-27","2026-02-27","2026-02-27","2026-02-27","2026-02-24","2026-02-23","2026-02-23","2026-04-30","2026-02-23","2026-02-23","2026-02-23","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-02-26","2026-02-26","2026-02-26","2026-03-28","2026-03-28","2026-03-28","2026-04-17","2026-04-29","2025-02-01","2025-02-05","2025-02-05"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","METFORMIN HCL ER","","","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":""}]}]}