{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lina M Gaviria","gend":1,"currentgend":"","add":"19 Ashley Street","city":"East Boston","state":"MA","zip":"02128","dob":"1987-09-15","age":"","mstatus":"","insh":"C0018485500","cliId":"","pno":"6179590881","cno":"","email":"","ename":"","eno":"","pphy":"Jaime G Gallegos Salazar","ppno":"6175695800","pcpadd":"20 Maverick Sq","pcpcity":"East Boston","pcpstate":"MA","pcpzip":"02128","pcpcounty":"","pcpid":"","pcpname":"NeighborHealth Corporation","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"Apt 2","add3":"","madd1":"19 Ashley Street","madd2":"Apt 2","madd3":"","mcity":"East Boston","mstate":"MA","mzip":"02128","pcpfaxno":"","pcpnpi":"1598022980","currentgendcomment":"","pphycomment":"","uniqueid":"95205700","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","F3289","M79671","G4700","G43809","J0130","N8111","N393","N8189","F529","Z302","M722","R5381","R52","R0981","R519","R208","R202","M7910","B029","Z01818","N812","N3641","N838","G43909","Z87891","Z79899","R10A1","M5450","R3129","R930","R6883","N816","N898","L719","D72828","N3946"],"date":["2026-05-23","2026-04-24","2025-11-04","2025-11-04","2026-03-06","2026-03-06","2025-09-25","2026-04-27","2026-04-07","2026-04-07","2026-05-01","2025-12-18","2026-03-06","2026-03-06","2026-03-04","2026-03-05","2026-03-04","2026-03-04","2026-03-05","2026-03-09","2026-04-07","2026-04-27","2026-04-27","2026-04-27","2026-04-27","2026-04-27","2026-04-27","2026-03-03","2026-03-03","2026-03-05","2026-03-05","2026-03-06","2026-04-27","2026-05-01","2025-06-09","2025-06-04","2025-06-09"],"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":[["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","DICLOFENAC POTASSIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","GABAPENTIN","","","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":""}]}]}