{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rashal Chahine","gend":1,"currentgend":"","add":"176 FORBES RD","city":"WESTWOOD","state":"MA","zip":"02090","dob":"1992-12-04","age":"","mstatus":"","insh":"C0010360500","cliId":"","pno":"7818886603","cno":"","email":"","ename":"","eno":"","pphy":"Walid S Farah","ppno":"6174723400","pcpadd":"700 Congress St, Ste 103","pcpcity":"Quincy","pcpstate":"MA","pcpzip":"02169","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"176 FORBES RD","madd2":"","madd3":"","mcity":"WESTWOOD","mstate":"MA","mzip":"02090","pcpfaxno":"","pcpnpi":"1184630857","currentgendcomment":"","pphycomment":"","uniqueid":"69833100","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10A1","M5440","M5450","N200","R3129","Z87448","R490","Q6211","R10A0","M5489","J0141","R99","N926","E282","E559","R5383","Z0000","Z1159","Z903","Z862","J342","D509","Z9884","J3489","J343","K219","Z79899","N1330","M5186","M4316","L680","N939","Z309","Z1389","Z1331","E663","E804","K589","Z833","K635","Z6830","R059","J029","Z30430","Z30432","N921","T8332XA","J310","R0982","J324","Z975","J329","H6992","J392","J069","R0981","J301","N132","R112","R1013","R0602","J348200"],"date":["2026-03-27","2026-03-27","2026-04-28","2026-05-01","2026-05-01","2026-04-28","2026-04-28","2026-05-01","2026-05-01","2026-05-01","2025-12-02","2026-05-08","2026-03-09","2026-03-09","2026-03-09","2025-09-16","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2026-03-12","2026-01-29","2026-01-29","2026-02-12","2026-02-12","2026-02-12","2026-02-12","2026-03-13","2026-04-29","2026-04-29","2026-03-09","2025-12-16","2025-09-30","2025-12-17","2025-10-31","2025-12-16","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2025-12-16","2025-11-22","2025-11-22","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2026-01-02","2026-01-02","2025-12-12","2025-12-17","2025-12-16","2026-01-02","2026-01-02","2026-01-02","2026-01-02","2026-02-03","2026-01-29","2026-03-12","2026-01-29","2026-01-29","2026-02-12"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AZELASTINE 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":""}]}]}