{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Shalom Keynan","gend":0,"currentgend":"","add":"5 SHAW RD","city":"CHESTNUT HILL","state":"MA","zip":"02467","dob":"1962-10-25","age":"","mstatus":"","insh":"C0040867501","cliId":"","pno":"6176974797","cno":"","email":"","ename":"","eno":"","pphy":"Lester  Shoap","ppno":"6175466100","pcpadd":"25 Boylston St, Ste 204","pcpcity":"Chestnut Hill","pcpstate":"MA","pcpzip":"02467","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 SHAW RD","madd2":"","madd3":"","mcity":"CHESTNUT HILL","mstate":"MA","mzip":"02467","pcpfaxno":"","pcpnpi":"1730158684","currentgendcomment":"","pphycomment":"","uniqueid":"157067851","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M792","R99","F988","N200","N5319","M7918","M542","Z0000","E785","E039","E1165","Z125","R5383","H11421","J349","M5412","Z4889","H0589","H1011","Z59869","Z1331","Z1339","M4802","S46011D","M961","H40012","H04123","M25512"],"date":["2026-05-16","2026-05-12","2026-04-16","2025-12-05","2025-12-05","2025-12-26","2026-02-13","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2025-12-08","2025-12-08","2025-12-15","2025-12-15","2026-04-29","2026-04-29","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2026-02-13","2026-04-29","2026-04-29","2026-05-12"],"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":[["","","PREGABALIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","CELECOXIB","","","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":""}]}]}