{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Margaret Apio","gend":1,"currentgend":"","add":"76 ST IVES WAY","city":"MARLBOROUGH","state":"MA","zip":"01752","dob":"1971-04-25","age":"","mstatus":"","insh":"C0028096500","cliId":"","pno":7814993714,"cno":"","email":"","ename":"","eno":"","pphy":"Shahnaz Z Montague","ppno":7747776200,"pcpadd":"109 Andrew Ave,Ste 101","pcpcity":"Wayland","pcpstate":"MA","pcpzip":"01778","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 24","add3":"","madd1":"76 ST IVES WAY","madd2":"APT 24","madd3":"","mcity":"MARLBOROUGH","mstate":"MA","mzip":"01752","pcpfaxno":"","pcpnpi":1457308249,"currentgendcomment":"","pphycomment":"","uniqueid":135138200,"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":["J069","D472","M25561","E66812","G8929","Z6836","Z1239","Z1211","Z131","Z0001","Z1331","E669","Z1339","Z1231","C9000","S238XXA","Z01818","Z5111","C9001","Z79899","Z79624","Z7982","Z7961","Z7952","F329","F1090","I951","D61818","R110","F3341","F4310","R99","Z52011","Z5112","R5383","Z23","Z9484","Z0000"],"date":["2024-11-27","2025-10-16","2025-01-16","2024-12-05","2025-01-16","2025-01-16","2025-02-13","2025-04-03","2024-12-05","2025-01-16","2025-01-16","2025-05-01","2025-01-16","2025-02-13","2026-01-15","2025-08-12","2025-09-15","2026-01-15","2026-01-15","2026-01-15","2025-04-03","2025-04-03","2025-04-03","2025-04-03","2025-04-03","2025-04-03","2025-04-03","2025-04-03","2025-12-22","2025-12-11","2025-12-11","2026-02-09","2024-10-17","2024-11-14","2024-11-14","2024-10-17","2024-11-14","2025-01-16"],"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":[["","","ACYCLOVIR","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","POMALYST","","","Select","Select",""],["","","NINLARO","","","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":""}]}]}