{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marie Marcelin-Leonard","gend":1,"currentgend":"","add":"132 SUMMIT ST","city":"HYDE PARK","state":"MA","zip":"02136","dob":"1973-01-19","age":"","mstatus":"","insh":"C0012060100","cliId":"","pno":"8572612669","cno":"","email":"","ename":"","eno":"","pphy":"Craig F Noronha","ppno":"6174145951","pcpadd":"801 Massachusetts Ave","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02118","pcpcounty":"","pcpid":"","pcpname":"Evans Medical Foundation, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"132 SUMMIT ST","madd2":"APT 1","madd3":"","mcity":"HYDE PARK","mstate":"MA","mzip":"02136","pcpfaxno":"","pcpnpi":"1881640084","currentgendcomment":"","pphycomment":"","uniqueid":"73146050","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":["R99","M5450","E042","E559","K219","K5904","K6289","G8929","D500","Z886","H35719","H25813","H04123","L811","L608","L604","C50411","Z171","G935","C50919","I890","R109","Z5986","R1013","Z1211","E236","Q0700","Z17421","K30","R42","R1031","Z800","H43811","E041","R5383","G932","R519","M25561","M25562","M5416","H903","Z0000","E663","R270","Z23","I872","L03012","G9389","M4312","G5603","R200","M5127","R922","Z853","N6310","R92332","L603","B353","Z5181"],"date":["2026-02-26","2025-10-27","2024-04-09","2024-08-07","2024-10-21","2024-04-23","2024-11-19","2025-10-21","2025-10-21","2025-10-21","2024-09-10","2025-09-16","2025-09-16","2026-01-22","2026-01-21","2024-06-17","2025-06-13","2024-06-14","2025-09-19","2025-10-29","2025-03-26","2024-12-31","2024-08-07","2024-11-19","2025-03-14","2024-10-07","2024-10-07","2025-10-29","2024-10-21","2025-10-21","2024-11-19","2025-03-14","2025-03-18","2025-10-21","2025-04-15","2025-09-03","2025-07-23","2025-08-25","2025-08-25","2025-12-10","2025-09-19","2025-10-21","2025-10-21","2025-10-21","2025-10-21","2026-01-22","2026-01-22","2024-07-03","2024-07-03","2024-07-10","2024-07-10","2025-10-24","2025-12-16","2025-12-16","2025-12-16","2025-12-16","2026-01-28","2026-01-08","2026-01-08"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","ACETAZOLAMIDE ER","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","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":""}]}]}