{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Shamika M Welch","gend":1,"currentgend":"","add":"37 CALLENDER ST APT 2","city":"DORCHESTER","state":"MA","zip":"02124","dob":"1988-03-22","age":"","mstatus":"","insh":"C0009825000","cliId":"","pno":6172971160,"cno":"","email":"","ename":"","eno":"","pphy":"Marta Escriu-Sune","ppno":6178228271,"pcpadd":"637 Washington St,","pcpcity":"Dorchester","pcpstate":"MA","pcpzip":"02124","pcpcounty":"","pcpid":"","pcpname":"Codman Square Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"37 CALLENDER ST APT 2","madd2":"","madd3":"","mcity":"DORCHESTER","mstate":"MA","mzip":"02124","pcpfaxno":"","pcpnpi":1891253795,"currentgendcomment":"","pphycomment":"","uniqueid":69256700,"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":["H8110","Z9884","G43909","G4700","G44209","R635","E519","Z713","Z7182","E663","G43111","Z124","A419","E876","M546","J189","D649","Z3042","E6601","E559","Z886","F4325","H60399","R519","H9201","F419","M26629","R12","R202","M5410","G4489","R6884","H04123","H52223","G44201","N644","F40243","R200","E669","M5481","F5105","E162","F99","R42","R9082","Z09","R110","R9389","G35","R930","G8929","M778","S0990XA","Z0000","R0602","Z452","J984","R7989","R059","D72829","R109","R079","R000","G43109","Z3009","R112","G5621","R99","Z5321","R9089","M26609","D509","Z6833","Z1152","Z79899"],"date":["2025-07-05","2025-11-06","2025-04-16","2024-05-10","2024-11-12","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-03-24","2025-09-04","2025-04-18","2025-11-06","2025-11-02","2025-11-06","2025-11-06","2025-12-08","2025-09-17","2025-11-06","2025-09-17","2025-07-08","2024-02-15","2024-09-28","2024-03-15","2025-09-04","2024-03-15","2025-09-04","2024-06-03","2024-06-03","2024-06-03","2024-04-16","2024-04-25","2024-04-25","2024-11-09","2024-01-05","2024-02-05","2024-02-05","2024-09-30","2024-11-09","2025-11-06","2024-09-18","2025-11-06","2025-04-16","2024-09-29","2025-04-24","2024-04-10","2024-01-10","2024-01-10","2024-02-10","2025-11-02","2025-05-04","2025-05-04","2025-09-04","2025-04-16","2025-04-16","2025-04-16","2025-04-16","2025-04-16","2025-04-18","2025-04-16","2025-04-18","2025-04-17","2025-04-17","2025-10-05","2025-11-06","2025-07-18","2025-12-17","2024-12-09","2024-09-30","2024-09-30","2024-09-30","2024-09-30","2024-09-30","2024-09-30"],"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":[["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FOLIC ACID","","","Select","Select",""],["","","PROPRANOLOL HCL","","","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":""}]}]}