{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David Armillotti","gend":0,"currentgend":"","add":"26 LOVELAND RD","city":"BROOKLINE","state":"MA","zip":"02445","dob":"1961-08-22","age":"","mstatus":"","insh":"C0017821000","cliId":"","pno":2079316629,"cno":"","email":"","ename":"","eno":"","pphy":"Anne M Barnard","ppno":6173968005,"pcpadd":"1180 Beacon St,Ste 1A","pcpcity":"Brookline","pcpstate":"MA","pcpzip":"02446","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"26 LOVELAND RD","madd2":"","madd3":"","mcity":"BROOKLINE","mstate":"MA","mzip":"02445","pcpfaxno":"","pcpnpi":1023404522,"currentgendcomment":"","pphycomment":"","uniqueid":93800300,"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":["E785","M25562","J45909","I10","R051","F418","R99","F32A","E1165","J4540","F4312","J4520","K5100","Z86010","Z800","E119","Z7984","K5730","K648","K51019","K51919","F331","Z131","S29011A","Z7952","K7689","R7989","K2960","K2289","K3189","K2100","Z0000","K760","Z125","N200","R350","M25512","G8929","Z9189","Z1211","E559","E039","D225","L821","L814","L818","Z872","Z7189","R0789","R9431","K5190","Z23","R809","R109","H43393","H25813","H35033","R1310","Z860100","K2900","Z0001","Z1331","G4733","Z1339","M5441","M25561","M5442","T887XXA"],"date":["2026-02-12","2025-09-17","2024-11-01","2026-02-12","2024-05-10","2024-06-12","2026-02-02","2024-10-15","2026-02-12","2025-02-14","2026-02-12","2025-09-17","2026-02-03","2024-08-01","2025-08-07","2026-01-13","2024-08-01","2024-08-01","2024-08-01","2025-04-18","2025-02-14","2025-09-17","2025-02-14","2025-02-19","2025-04-18","2025-06-06","2025-06-06","2025-08-07","2025-08-07","2025-08-07","2025-08-07","2025-09-17","2026-02-03","2025-09-17","2025-09-17","2025-09-17","2025-10-14","2025-10-14","2024-08-01","2024-08-01","2024-11-01","2024-11-01","2025-01-07","2025-01-07","2025-01-07","2025-01-07","2025-01-07","2025-01-07","2025-02-19","2025-02-20","2025-04-18","2025-09-17","2025-05-15","2025-05-15","2025-06-24","2025-06-24","2025-06-24","2026-02-03","2025-08-05","2025-08-07","2025-09-17","2025-09-17","2025-09-17","2025-09-17","2025-09-18","2025-09-17","2025-09-18","2026-01-13"],"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",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","MOUNJARO","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}