{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard Frias Perez","gend":0,"currentgend":"","add":"3 BIRD ST","city":"BOSTON","state":"MA","zip":"02125","dob":"2001-09-06","age":"","mstatus":"","insh":"C0018422401","cliId":"","pno":8577199202,"cno":"","email":"","ename":"","eno":"","pphy":"Elise M Henricks","ppno":6172878000,"pcpadd":"500 Columbia Rd,","pcpcity":"Dorchester","pcpstate":"MA","pcpzip":"02125","pcpcounty":"","pcpid":"","pcpname":"Upham's Corner Health Committee, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 4","add3":"","madd1":"3 BIRD ST","madd2":"APT 4","madd3":"","mcity":"BOSTON","mstate":"MA","mzip":"02125","pcpfaxno":"","pcpnpi":1154392850,"currentgendcomment":"","pphycomment":"","uniqueid":95127051,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J4520","Z91013","R99","F649","F341","S40811A","S40812A","S50811A","S80212A","S80211A","S60511A","M25511","M79645","Z131","F331","F419","F330","Z0000","Z113","Z558","Z8679","T07XXXA","R41840","S40819A","S60512A","M79641","M7989","M79642","M79631","M25521","M25531","R12","R109","F3289","R1084","R4689","Z7189","F429","F909","Z202"],"date":["2025-01-17","2024-04-10","2025-12-09","2026-01-27","2026-01-27","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2025-03-11","2025-10-07","2026-01-27","2026-02-03","2024-04-09","2026-02-11","2024-04-09","2024-04-09","2024-06-11","2026-01-13","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-05-25","2024-08-01","2024-08-01","2025-03-11","2025-03-29","2026-01-13","2026-01-13","2026-01-27","2026-02-02","2026-02-11"],"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",""],["","","EPINEPHRINE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLULAVAL TRIVALENT 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","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":""}]}]}