{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marlene Eltima","gend":1,"currentgend":"","add":"84 BAILEY ST","city":"DORCHESTER","state":"MA","zip":"02124","dob":"1975-08-13","age":"","mstatus":"","insh":"C0038140900","cliId":"","pno":"2392414012","cno":"","email":"","ename":"","eno":"","pphy":"Ife J Tracy","ppno":"6174142080","pcpadd":"960 Massachusetts Ave, 3448-A","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02118","pcpcounty":"","pcpid":"","pcpname":"Evans Medical Foundation, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"84 BAILEY ST","madd2":"APT 2","madd3":"","mcity":"DORCHESTER","mstate":"MA","mzip":"02124","pcpfaxno":"","pcpnpi":"1497373799","currentgendcomment":"","pphycomment":"","uniqueid":"152481950","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Creoles & Pidgin (FRE)"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1169","Z794","M25461","E1165","R229","I10","M25561","G8929","Z0000","M79671","M79672","R1319","Z59869","K449","R1310","E119","K2289","G4452","M542","R519","R2241","M7121","M722","E1142","L859","M2011","L905","M2042","B353","M2012","M2041","R99","M19071","Z23","Z7984"],"date":["2026-04-30","2026-04-30","2026-04-13","2026-04-13","2026-05-11","2026-04-30","2026-04-30","2026-04-30","2025-08-14","2026-02-02","2026-02-02","2026-01-29","2026-01-29","2026-02-05","2026-02-05","2026-02-05","2026-02-09","2026-03-05","2026-03-05","2026-03-05","2026-04-13","2026-04-13","2026-02-02","2026-05-27","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-04-13","2026-02-02","2026-02-02","2026-05-04","2026-04-13","2025-10-27","2026-02-05"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","TRUEPLUS LANCETS","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","ALCOHOL PREP PADS","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","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":""}]}]}