{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dolores Icuspit","gend":1,"currentgend":"","add":"9 GLENDALE RD","city":"NORWOOD","state":"MA","zip":"02062","dob":"1960-03-20","age":"","mstatus":"","insh":"C0033698001","cliId":"","pno":7813089483,"cno":"","email":"","ename":"","eno":"","pphy":"Isabel A Lamour","ppno":7817849212,"pcpadd":"4 Washington St,Fl 1","pcpcity":"Canton","pcpstate":"MA","pcpzip":"02021","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 GLENDALE RD","madd2":"","madd3":"","mcity":"NORWOOD","mstate":"MA","mzip":"02062","pcpfaxno":"","pcpnpi":1730474826,"currentgendcomment":"","pphycomment":"","uniqueid":145674651,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R059","J40","J45909","I10","R99","J00","E7800","Z01818","M2011","G8918","M19071","Z7951","Z79899","Z8612","Z885","Z888","R52","Z0000","E119","M2042","R7303","E785","T7849XA","H00021","H00022","H00024","H00025","H04123","Z136","M21862","S93145A","S93142A","Z98890","M21611"],"date":["2025-11-19","2025-11-19","2025-11-19","2025-03-12","2025-07-09","2025-11-08","2025-09-29","2025-08-01","2025-08-01","2025-01-15","2025-02-26","2025-01-15","2025-01-15","2025-04-25","2025-01-15","2025-01-15","2025-02-26","2025-02-05","2025-09-29","2024-11-27","2024-04-10","2024-04-10","2024-04-10","2024-10-28","2024-10-28","2024-10-28","2024-10-28","2024-10-28","2025-08-01","2024-11-27","2024-11-27","2024-11-27","2025-01-14","2025-01-14"],"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":[["","","PROMETHAZINE-DM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","GUAIFENESIN-CODEINE","","","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":""}]}]}