{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jina Coelho","gend":1,"currentgend":"","add":"322 Revere Street","city":"Winthrop","state":"MA","zip":"02152","dob":"1964-08-26","age":"","mstatus":"","insh":"C0024162000","cliId":"","pno":6178239419,"cno":"","email":"","ename":"","eno":"","pphy":"Cindy Levine","ppno":6179756200,"pcpadd":"1000 Broadway,","pcpcity":"Chelsea","pcpstate":"MA","pcpzip":"02150","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"322 Revere Street","madd2":"","madd3":"","mcity":"Winthrop","mstate":"MA","mzip":"02152","pcpfaxno":"","pcpnpi":1437137270,"currentgendcomment":"","pphycomment":"","uniqueid":106305800,"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":["R99","I4710","E669","K644","R002","L531","L304","J3489","L219","L814","L821","J069","R5383","Z20822","R1084","E782","K2270","E063","G4733","R600","Z6835","E785","E559","F32A","F4310","J45909","E042","J342","E6601","K219","J4520","Z6832","K589","R509","J4521","R42","Z0000","M797","L409","E66811","T887XXA","M2550","M542","F3342","F419","Z6834","Z1331","Z8679","Z1231","Z1339","M249","E041","R0789","E6609","Q7962","Z6833","Z1211","H0100A","H2513","H5213","H0100B","K5730","K648","K649","M5412","G90A","Z6831","L299","L905","K5790","K5909","K2100","Z8719","L820"],"date":["2026-01-19","2026-01-12","2026-01-12","2025-12-01","2026-01-12","2026-01-06","2026-01-06","2024-09-17","2026-01-06","2026-01-06","2026-01-06","2024-12-02","2025-10-28","2024-05-19","2024-07-11","2026-01-12","2025-10-14","2025-12-01","2025-12-01","2024-07-12","2024-07-12","2025-12-08","2024-07-12","2025-12-01","2025-12-01","2025-12-01","2025-12-01","2024-07-12","2024-07-12","2025-12-01","2025-10-14","2025-10-14","2024-12-02","2024-12-02","2024-12-02","2025-01-02","2025-01-14","2025-04-14","2025-04-14","2025-04-14","2025-01-14","2025-01-14","2025-03-03","2025-01-14","2025-12-01","2025-01-14","2025-01-14","2025-01-14","2025-04-01","2025-01-14","2025-03-04","2025-04-01","2026-01-12","2025-04-14","2026-01-12","2025-04-14","2025-09-12","2025-09-03","2025-09-03","2025-09-03","2025-09-03","2025-09-12","2025-12-01","2025-10-14","2025-10-14","2026-01-12","2025-12-01","2026-01-06","2024-09-09","2025-09-12","2025-09-25","2025-09-25","2025-09-25","2026-01-06"],"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":[["","","ZEPBOUND","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","GUAIFENESIN-CODEINE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","IVABRADINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","KETOCONAZOLE","","","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":""}]}]}