{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Scott Bachman","gend":0,"currentgend":"","add":"137 Marlborough Street","city":"boston","state":"MA","zip":"02116","dob":"1963-05-29","age":"","mstatus":"","insh":"C0006004100","cliId":"","pno":6178759668,"cno":"","email":"","ename":"","eno":"","pphy":"Vincent Paquette","ppno":6173968866,"pcpadd":"822 Boylston St,Ste 102","pcpcity":"Chestnut Hill","pcpstate":"MA","pcpzip":"02467","pcpcounty":"","pcpid":"","pcpname":"Revere Medical of Massachusetts, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"137 Marlborough Street","madd2":"","madd3":"","mcity":"boston","mstate":"MA","mzip":"02116","pcpfaxno":"","pcpnpi":1851385389,"currentgendcomment":"","pphycomment":"","uniqueid":65911600,"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":["J4540","R99","J869","F419","E7800","R1310","J8489","S0101XA","M21371","M79661","R531","G610","G5621","I2510","K220","J95811","Z4682","J189","T8182XA","J939","R12","M47816","R519","T1490XA","Z0001","J4520","R030","M722","Z87442","Z8709","G629","S0181XA","Z1211","K2289","Q399","K2100","H6121","H938X1","E785","E66811","Z6832","R4702","K219","J45909","E871","J90","R600","S0990XA","K439","R918","J9589","J8410","Z48815","R109","D62","I959","Z7951","Z79899","J984","G43909","E781","Z23","D72829","Z79891","M5134","G603","I10","Z98890","Z01818","J690","K5909","K831","E6609","Z6833","R059","M79605","M7989","Z48813","J9811","R0602","Z20822"],"date":["2024-02-14","2025-11-09","2025-08-27","2025-07-16","2025-10-29","2025-05-27","2024-02-20","2024-03-20","2025-07-16","2024-08-05","2024-08-05","2025-04-25","2024-05-15","2024-09-02","2025-09-09","2024-02-18","2024-08-02","2025-08-27","2024-12-02","2024-02-15","2024-09-13","2024-03-20","2024-03-20","2024-03-20","2024-09-24","2025-07-22","2024-09-24","2024-09-24","2025-07-16","2024-09-24","2024-10-17","2024-03-20","2024-11-11","2025-08-27","2025-02-01","2024-12-23","2024-12-23","2024-12-23","2025-08-27","2024-12-23","2024-12-23","2025-12-03","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2025-07-17","2025-07-17","2025-07-16","2025-08-28","2025-08-28","2024-02-02","2024-02-02","2025-07-16","2025-07-16","2024-02-02","2025-07-16","2024-02-02","2024-03-20","2024-03-20","2024-03-20","2024-03-29","2024-05-15","2025-08-27","2025-07-16","2025-09-07","2025-07-16","2025-07-16","2025-08-27","2025-08-27","2025-08-27","2024-02-02","2024-02-02","2024-02-02","2024-02-02","2024-07-02","2024-06-02","2024-02-02"],"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":[["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","NIFEDIPINE ER","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUBLOK 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":""}]}]}