{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Olympia Martins","gend":1,"currentgend":"","add":"37 WELLINGTON HILL ST","city":"MATTAPAN","state":"MA","zip":"02126","dob":"1981-07-02","age":"","mstatus":"","insh":"C0021577900","cliId":"","pno":6176767071,"cno":"","email":"","ename":"","eno":"","pphy":"Stephen Wilson","ppno":6174142080,"pcpadd":"11 Melnea Cass Blvd,","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02119","pcpcounty":"","pcpid":"","pcpname":"Boston University Family Medicine,Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"37 WELLINGTON HILL ST","madd2":"APT 2","madd3":"","mcity":"MATTAPAN","mstate":"MA","mzip":"02126","pcpfaxno":"","pcpnpi":1679512792,"currentgendcomment":"","pphycomment":"","uniqueid":101315900,"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":["R99","G44029","J209","I10","F17200","Z1231","J309","L918","Z23","Z0000","Z886","J4520","F3281","R030","E66811","Z6830","E6609","G8911","M5450","F17210","V4940XA","R1030","R112","R197","R1032","F411","F1090"],"date":["2025-12-13","2025-08-25","2024-02-10","2025-12-16","2025-08-25","2024-06-02","2024-06-02","2024-06-02","2024-06-02","2024-02-12","2024-02-12","2025-08-25","2024-02-12","2025-08-25","2025-08-25","2025-08-25","2025-08-25","2025-08-19","2025-08-19","2025-10-12","2025-08-19","2025-10-12","2025-10-12","2025-10-12","2025-10-12","2025-12-16","2025-12-16"],"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":[["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","VERAPAMIL HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","","","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":""}]}]}