{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra Ortiz","gend":1,"currentgend":"","add":"20 AMORY AVE","city":"ROXBURY","state":"MA","zip":"02119","dob":"1974-09-11","age":"","mstatus":"","insh":"C0030217100","cliId":"","pno":"8573170599","cno":"","email":"","ename":"","eno":"","pphy":"Darryl A Woods","ppno":"6174145946","pcpadd":"850 Harrison Ave","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02118","pcpcounty":"","pcpid":"","pcpname":"Child Health Foundation Of Boston, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 5C","add3":"","madd1":"20 AMORY AVE","madd2":"APT 5C","madd3":"","mcity":"ROXBURY","mstate":"MA","mzip":"02119","pcpfaxno":"","pcpnpi":"1508882341","currentgendcomment":"","pphycomment":"","uniqueid":"139401200","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","H11001","H11051","R140","Z0000","Z1231","F5102","Z23","Z86010","H04123","H2513","I10","Z13820","C641","E210","R002","R160","R55","R4182","R4589","M25531","E66811","S62114A","Z6833","E6609","Z6834","R413","F419","G4700","F32A","E213","M859","Z6830","Z599","J302","E663","Z1211","S52509D","R519","Z0389"],"date":["2026-02-27","2024-04-22","2024-05-21","2024-12-10","2026-02-09","2025-08-19","2024-12-10","2025-12-04","2024-08-30","2024-12-18","2024-12-18","2026-02-11","2025-07-10","2025-04-15","2024-12-10","2024-12-10","2024-12-10","2024-09-17","2024-09-17","2024-09-17","2025-10-27","2025-10-27","2025-04-03","2025-04-24","2025-10-27","2025-06-20","2025-05-22","2025-05-22","2025-05-22","2025-05-22","2025-07-10","2025-07-10","2025-10-27","2025-10-27","2025-10-27","2025-12-04","2024-08-30","2025-07-10","2026-02-10","2026-02-10"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","ESTRADIOL (ONCE WEEKLY)","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","PHENTERMINE HCL","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","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":""}]}]}