{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Abby N Smuckler Lotwin","gend":1,"currentgend":"","add":"120 LINDEN ST","city":"NEEDHAM","state":"MA","zip":"02492","dob":"1967-09-05","age":"","mstatus":"","insh":"C0028828501","cliId":"","pno":7814492821,"cno":"","email":"","ename":"","eno":"","pphy":"Linda C Tsai","ppno":7814533765,"pcpadd":"148 Chestnut St,","pcpcity":"Needham","pcpstate":"MA","pcpzip":"02492","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"120 LINDEN ST","madd2":"","madd3":"","mcity":"NEEDHAM","mstate":"MA","mzip":"02492","pcpfaxno":"","pcpnpi":1750489449,"currentgendcomment":"","pphycomment":"","uniqueid":137546001,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1013","R99","T691XXA","K5090","Z713","K50919","M810","R945","I7300","M2550","K50818","Z79620","K50019","M79641","M79642","Z0000","K7400","K50819","Z5112","K5080","M4722","M25511","M25512","M25562","E559","E213","Z7952"],"date":["2024-12-18","2025-12-24","2025-12-19","2024-12-04","2024-12-04","2024-05-13","2025-11-04","2024-12-04","2025-08-01","2024-05-13","2024-12-06","2025-08-01","2025-08-01","2024-03-21","2024-03-21","2025-07-15","2024-07-02","2024-05-28","2024-08-20","2024-11-12","2025-01-17","2025-01-17","2025-01-17","2025-03-31","2025-11-04","2025-11-04","2025-01-07"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","PENTOXIFYLLINE","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","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":""}]}]}