{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Katia Nieves Mercedes","gend":1,"currentgend":"","add":"22 Greenheys Street","city":"Dorchester","state":"MA","zip":"02121","dob":"1974-06-02","age":"","mstatus":"","insh":"C0020852200","cliId":"","pno":"8573995076","cno":"","email":"","ename":"","eno":"","pphy":"Jennifer J VanderWeele","ppno":"6178259660","pcpadd":"637 Washington St","pcpcity":"Dorchester","pcpstate":"MA","pcpzip":"02124","pcpcounty":"","pcpid":"","pcpname":"Codman Square Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"Apt 2","add3":"","madd1":"22 Greenheys Street","madd2":"Apt 2","madd3":"","mcity":"Dorchester","mstate":"MA","mzip":"02121","pcpfaxno":"","pcpnpi":"1841682127","currentgendcomment":"","pphycomment":"","uniqueid":"99986900","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":["E221","N951","Z1211","D122","K648","G44229","Z79899","D352","Z13228","G44221","H04123","H2513","H40003","E66811","E6609","Z6832","G4485","G4733","F5105","F99","B009","K635","K649","M79604","M79651","F419","F330","E663","R7303","E7800","F4322","R99","H547","Z124"],"date":["2026-03-05","2026-03-25","2026-01-21","2026-01-13","2026-01-09","2026-01-13","2026-01-13","2026-03-10","2026-03-10","2026-04-14","2025-07-23","2025-07-23","2025-07-23","2026-01-21","2026-01-21","2026-01-21","2026-04-14","2025-09-02","2025-10-08","2025-10-08","2025-12-08","2026-01-09","2026-01-09","2026-01-21","2026-01-22","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-04-14","2025-07-23","2025-02-24"],"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":[["","","WEGOVY","","","Select","Select",""],["","","CABERGOLINE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","INDOMETHACIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","ESTRADIOL (ONCE WEEKLY)","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","SUPREP","","","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":""}]}]}