{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jonathan E Ambrosino","gend":0,"currentgend":"","add":"61 FLORENCE AVE","city":"ARLINGTON","state":"MA","zip":"02476","dob":"1965-10-26","age":"","mstatus":"","insh":"C0034550500","cliId":"","pno":"6172518288","cno":"","email":"","ename":"","eno":"","pphy":"Laura  Desrochers","ppno":"6177549600","pcpadd":"330 Brookline Ave","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02215","pcpcounty":"","pcpid":"","pcpname":"Harvard Medical Faculty Physicians At Beth Israel Medic","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"61 FLORENCE AVE","madd2":"","madd3":"","mcity":"ARLINGTON","mstate":"MA","mzip":"02476","pcpfaxno":"","pcpnpi":"1861052227","currentgendcomment":"","pphycomment":"","uniqueid":"147281550","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":["J329","R059","R99","M25511","M25512","H1033","C8334","M7541","M7542","G8929","Z0001","Z0000","C833A","R7301","R350","M79604","Z23","Z125","M7521","M19012","H6123","J00","J029","R0981","H6121","M65341","G629","R0602","R599","R29898","Z13220","Z452"],"date":["2025-07-30","2025-07-30","2025-11-15","2026-05-14","2026-05-14","2025-07-30","2026-03-11","2025-09-16","2025-09-16","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2025-07-21","2025-07-21","2025-07-31","2025-07-31","2025-07-30","2025-07-30","2025-07-30","2026-05-14","2025-02-26","2025-03-13","2025-03-10","2025-03-10","2025-03-10","2025-04-07"],"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":[["","","ENTECAVIR","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","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":""}]}]}