{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bienvenida Perez","gend":1,"currentgend":"","add":"104 1st ave","city":"charlestown","state":"MA","zip":"02129","dob":"1958-06-23","age":"","mstatus":"","insh":"C0010145700","cliId":"","pno":"8608818820","cno":"","email":"","ename":"","eno":"","pphy":"Elise M Henricks","ppno":"6172878000","pcpadd":"500 Columbia Rd","pcpcity":"Dorchester","pcpstate":"MA","pcpzip":"02125","pcpcounty":"","pcpid":"","pcpname":"Upham's Corner Health Committee, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"apt 214","add3":"","madd1":"104 1st ave","madd2":"apt 214","madd3":"","mcity":"charlestown","mstate":"MA","mzip":"02129","pcpfaxno":"","pcpnpi":"1154392850","currentgendcomment":"","pphycomment":"","uniqueid":"69583200","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":["M3310","Z87891","L942","Z5181","L810","M3313","Z1231","N9089","R079","L271","T50Z15A","M8589","D638","Z111","E119","M7062","M7540","M7918","L853","K130","H04123","H11003","H2513","M549","E039","I159","Z13820","K089","G8929","E8359","K219","R1012","Z23","H5203","H52203","H25813","H524","K649","D280","K6289","N952","R99","R059","B353","B351","M439","K0889","R196","M5450","I10","Z7982","M5431","M533","R269","H1132","F32A","F419","M542","G629","J328","T50905A","J040","Z79899"],"date":["2026-03-10","2026-02-05","2025-09-30","2026-03-03","2025-09-30","2026-04-14","2025-12-02","2026-02-03","2026-02-05","2026-02-05","2026-02-05","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2026-03-10","2026-03-10","2026-03-10","2026-03-03","2026-03-03","2025-11-20","2025-11-20","2025-08-07","2025-08-11","2025-08-11","2025-08-11","2025-08-11","2025-08-11","2025-08-11","2025-07-15","2025-08-26","2025-08-26","2025-10-30","2025-11-20","2025-11-20","2025-11-20","2025-11-20","2026-02-03","2026-01-29","2026-01-29","2026-02-03","2026-05-06","2026-01-09","2025-05-20","2025-05-20","2024-07-08","2024-08-06","2024-08-06","2025-05-10","2025-05-10","2025-05-10","2025-06-14","2025-06-14","2025-06-14","2025-06-24","2025-02-03","2024-12-02","2024-09-12","2024-07-23","2025-02-28","2025-05-20","2025-06-20","2024-09-16"],"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",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MYCOPHENOLIC ACID","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MYCOPHENOLATE MOFETIL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","TERBINAFINE HCL","","","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":""}]}]}