{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Massiel Tolentino","gend":1,"currentgend":"","add":"18 MACARTHUR RD","city":"PEABODY","state":"MA","zip":"01960","dob":"2003-01-18","age":"","mstatus":"","insh":"C0033803501","cliId":"","pno":"7815026907","cno":"7815026907","email":"","ename":"","eno":"","pphy":"Ashley A Warner","ppno":"7813962000","pcpadd":"101 Main St, Ste 116","pcpcity":"Medford","pcpstate":"MA","pcpzip":"02155","pcpcounty":"","pcpid":"","pcpname":"Hallmark Health Medical Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"890 FRANKLIN ST","madd2":"UNIT 2","madd3":"","mcity":"MELROSE","mstate":"MA","mzip":"02176","pcpfaxno":"","pcpnpi":"1790714079","currentgendcomment":"","pphycomment":"","uniqueid":"145785151","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F411","F900","F330","M2142","Z7251","Z30011","J069","N390","Z0000","R7301","Z23","E559","R142","R42","E538","D509","R21","Z124","L210","B3731","N898","J4540","Z202","N926","R99","Z3041","R52","F331","F902","F909"],"date":["2026-01-26","2026-01-26","2026-01-26","2024-11-12","2025-01-31","2025-01-31","2024-12-27","2025-03-03","2025-05-16","2025-05-16","2025-05-16","2025-08-08","2025-08-11","2025-05-16","2025-08-08","2025-05-16","2025-06-02","2025-06-02","2025-11-13","2025-06-06","2025-06-02","2025-08-08","2025-11-06","2025-05-19","2025-11-20","2025-11-27","2024-11-12","2025-04-29","2025-11-17","2025-06-05"],"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":[["","","ALTAVERA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","VIENVA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","METHYLPHENIDATE ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AVIANE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","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":""}]}]}