{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tewabech H Golla","gend":1,"currentgend":"","add":"14 LIBERTY AVENUE","city":"WOBURN","state":"MA","zip":"01801","dob":"1965-01-26","age":"","mstatus":"","insh":"C0004375101","cliId":"","pno":7814910018,"cno":"","email":"","ename":"","eno":"","pphy":"Jessica L Taylor","ppno":6174145951,"pcpadd":"801 Massachusetts Ave,","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02118","pcpcounty":"","pcpid":"","pcpname":"Evans Medical Foundation, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 LIBERTY AVENUE","madd2":"","madd3":"","mcity":"WOBURN","mstate":"MA","mzip":"01801","pcpfaxno":"","pcpnpi":1891057600,"currentgendcomment":"","pphycomment":"","uniqueid":63059701,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","R809","B029","E119","H2513","H04129","H40013","M6289","R102","N812","R3982","N9410","N952","M5440","G8929","N8110","Z0000","E1165","Z23","N644","R300","N3000","M5410","M533","B181","E782","M810","M19049","B354","L292","R0789","E785","K219","E66811","Z6833","Z79899","M47814","M47812","Z886","Z7984","R1013","M940","Z1231","M25511","M25811","M25512","M25812","N12","K5900","Z7985","M7910","R0781","N390","B0229","H04123"],"date":["2025-12-16","2025-10-14","2025-10-14","2025-12-02","2025-10-21","2024-04-15","2025-10-21","2024-11-15","2024-06-25","2024-06-25","2024-10-25","2024-02-05","2024-02-05","2024-02-05","2025-09-16","2024-02-05","2025-02-24","2025-10-14","2024-05-29","2024-05-24","2024-06-25","2024-06-25","2024-11-15","2024-11-15","2025-05-19","2025-12-02","2024-10-15","2024-10-15","2024-10-15","2024-10-25","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-01-29","2025-05-19","2025-05-31","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-09-22","2025-09-22","2025-09-22","2025-09-24","2025-09-24","2025-09-24","2025-10-14","2025-10-21"],"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":[["","","ESTRADIOL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","TRUEPLUS LANCETS","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TELMISARTAN","","","Select","Select",""],["","","VALACYCLOVIR","","","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":""}]}]}