{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Faith Bolivar","gend":1,"currentgend":"","add":"1 ROGERS DR","city":"WORCESTER","state":"MA","zip":"01604","dob":"1971-05-13","age":"","mstatus":"","insh":"C0033442400","cliId":"","pno":"6174583565","cno":"","email":"","ename":"","eno":"","pphy":"Elisabeth C Bassler","ppno":"7814743110","pcpadd":"372 Washington St","pcpcity":"Wellesley","pcpstate":"MA","pcpzip":"02481","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 ROGERS DR","madd2":"","madd3":"","mcity":"WORCESTER","mstate":"MA","mzip":"01604","pcpfaxno":"","pcpnpi":"1669580809","currentgendcomment":"","pphycomment":"","uniqueid":"145290650","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":["N951","R99","J45909","M5432","E7849","K219","M48062","N959","E790","Z23","G43709","G4700","F331","F411","F902","M1380","E66811","Z0184","Z1231","M79672","L603","D485","M19071","M7731","M2011","M461","R21","F909","F1111","J0100","Z0001","Z1331","R7302","E785","Z6834","D126","Z8349","Z1339","L301","J329","J069","B9689","F330","E782","Z566","M2550","M79673","M1000","R635","R7303","B353","B351"],"date":["2025-01-10","2026-02-16","2024-11-07","2024-11-24","2024-12-04","2025-10-30","2025-10-08","2025-11-13","2025-12-14","2025-10-31","2025-11-25","2026-02-04","2026-02-04","2026-02-05","2026-02-04","2026-02-20","2025-02-03","2025-03-18","2025-04-16","2025-10-30","2025-12-16","2026-01-05","2025-12-16","2025-12-16","2025-12-16","2025-12-22","2026-01-05","2025-09-22","2026-02-04","2024-11-06","2025-02-03","2025-06-12","2025-10-30","2025-02-03","2025-10-30","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-04-14","2025-04-14","2025-04-14","2025-06-12","2025-10-30","2025-10-30","2025-12-22","2025-12-16","2025-12-16","2025-12-16","2025-12-16","2025-12-16","2025-12-16"],"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":[["","","PROGESTERONE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","GUANFACINE HCL ER","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ESTRADIOL (TWICE WEEKLY)","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","VILAZODONE HCL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","EMGALITY PEN","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ETODOLAC","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","LEFLUNOMIDE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}