{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carly T Lazarus","gend":1,"currentgend":"","add":"11 KINROSS RD","city":"BRIGHTON","state":"MA","zip":"02135","dob":"1995-12-03","age":"","mstatus":"","insh":"C0027541800","cliId":"","pno":"7814082168","cno":"","email":"","ename":"","eno":"","pphy":"Michelle Y Buescher","ppno":"6172670900","pcpadd":"1340 Boylston St","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02215","pcpcounty":"","pcpid":"","pcpname":"Fenway Community Health Center, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"# 1","add3":"","madd1":"11 KINROSS RD","madd2":"# 1","madd3":"","mcity":"BRIGHTON","mstate":"MA","mzip":"02135","pcpfaxno":"","pcpnpi":"1811368426","currentgendcomment":"","pphycomment":"","uniqueid":"133207300","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","E282","S0300XD","R112","R197","Z87891","F411","G4733","M26623","M5450","F458","E669","G4721","M26629","Z23","G8929","N3000","F330","M542","S134XXD","S76012D","M25552","K610","M25559","S73109D","S76019D","M25659","M4010","Z0000","R7303","Z124","Z1339","R030","Z1321","H9201","R590","R110","L7211","L729","R3915","R350","F332","F4310","F1220","N912","R059","F3181","L720","R239","R519","Z87898","R1031","F419","F331","L680","R52","Z20822","R5383","Z3202","M79652","J189","J168"],"date":["2026-04-30","2026-03-12","2025-10-17","2025-08-06","2025-08-06","2025-08-06","2026-04-21","2025-08-19","2025-07-25","2025-07-25","2025-08-19","2025-08-19","2025-08-19","2025-10-17","2025-10-17","2025-10-17","2025-12-31","2026-04-21","2025-05-19","2025-05-19","2025-02-20","2025-02-20","2025-01-15","2025-05-19","2025-05-19","2025-05-19","2025-05-19","2025-05-19","2025-06-13","2025-06-13","2025-06-13","2025-06-13","2025-06-13","2025-06-13","2025-05-28","2025-05-28","2024-10-01","2024-08-27","2024-10-01","2024-10-17","2025-01-07","2025-01-17","2025-01-17","2025-01-17","2024-10-24","2025-01-29","2024-07-03","2024-09-03","2024-09-03","2024-10-01","2024-10-23","2024-10-17","2024-11-26","2024-08-29","2024-11-26","2024-12-16","2024-07-26","2024-07-26","2024-07-26","2025-01-06","2025-01-13","2025-01-11"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","JUNEL FE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","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":""}]}]}