{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria E Alves","gend":1,"currentgend":"","add":"101 Westville St","city":"Dorchester","state":"MA","zip":"02124","dob":"1966-10-26","age":"","mstatus":"","insh":"C0031920400","cliId":"","pno":"8578005249","cno":"","email":"","ename":"","eno":"","pphy":"Kathleen L Barry","ppno":"6177540100","pcpadd":"230 Bowdoin St","pcpcity":"Dorchester","pcpstate":"MA","pcpzip":"02122","pcpcounty":"","pcpid":"","pcpname":"Beth Israel DeaconessMedical Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"2","add3":"","madd1":"101 WESTVILLE ST","madd2":"2","madd3":"","mcity":"Dorchester","mstate":"MA","mzip":"02124","pcpfaxno":"","pcpnpi":"1790860583","currentgendcomment":"","pphycomment":"","uniqueid":"142387000","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Creoles & Pidgin (POR)"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","M65312","I10","L309","L249","M79642","Z113","N898","R102","K219","F32A","K760","R7303","Z7952","Z79899","K3189","M546","M549","E559","G5602","E785","R5383","Z860100","Z791","Z888","Z0001","Z0000","Z23","Z8619","Z124","N952","R0789","Z01411","Z1331","R079","H04123","H11003","H43811","Q141","H02883","H02886","R933","D490","H43391","G8929","M79645","R109","J101","K635","Z1231","R9230","R9389","Z7189","Z1211","H11043","M19042","R1031","D259","Z006"],"date":["2026-05-15","2025-10-08","2026-03-23","2025-08-08","2025-08-08","2025-08-13","2025-08-21","2025-08-21","2025-08-21","2026-02-11","2026-02-11","2026-02-11","2026-02-11","2025-09-02","2026-02-11","2026-02-11","2025-12-08","2026-01-06","2025-12-31","2025-12-31","2025-12-31","2025-12-31","2026-02-11","2026-02-11","2026-02-11","2026-03-10","2026-03-10","2026-03-10","2026-03-10","2026-03-10","2026-03-10","2026-03-24","2026-03-10","2026-03-10","2026-03-24","2026-04-02","2026-04-02","2026-04-02","2026-04-02","2026-04-02","2026-04-02","2026-02-11","2026-02-11","2024-09-12","2024-09-11","2024-09-11","2024-12-30","2025-01-24","2025-05-12","2025-03-11","2025-03-11","2025-03-28","2025-05-05","2025-05-12","2024-09-03","2024-09-11","2024-12-30","2024-12-30","2025-03-14"],"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",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","MISOPROSTOL","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","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":""}]}]}