{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Andrew Taylor","gend":0,"currentgend":"","add":"4 Woburn ST","city":"WORCESTER","state":"MA","zip":"01606","dob":"1993-11-18","age":"","mstatus":"","insh":"C0025355900","cliId":"","pno":9178704352,"cno":"","email":"","ename":"","eno":"","pphy":"Peter Z Li","ppno":6177342433,"pcpadd":"1180 Beacon St,Ste 8A","pcpcity":"Brookline","pcpstate":"MA","pcpzip":"02446","pcpcounty":"","pcpid":"","pcpname":"Medical Care of Boston Management Corp.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"C","add3":"","madd1":"4 Woburn ST","madd2":"C","madd3":"","mcity":"WORCESTER","mstate":"MA","mzip":"01606","pcpfaxno":"","pcpnpi":1154617082,"currentgendcomment":"","pphycomment":"","uniqueid":108772100,"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":["J309","R99","M5450","R053","F419","F4011","M25561","R059","M5430","Z79899","Z113","Z0000","R112","R197","R519","M461","G8929","J302","E663","E785","F5101","Z0001","Z1339","Z1331","S83203D","M25511","M25571","R7303","R7989","Z205","F411","N521","Z131","Z1329","Z112","Z136","M5416","L568","M9973","M5117","M4727","M7121"],"date":["2024-10-19","2025-10-28","2025-09-15","2025-02-04","2024-11-20","2025-04-30","2025-10-13","2025-04-03","2025-12-31","2024-04-29","2025-10-27","2025-10-27","2025-08-02","2025-08-02","2025-08-02","2025-06-30","2025-10-13","2025-03-24","2024-12-04","2025-03-24","2024-12-04","2024-04-29","2025-10-27","2025-10-27","2024-04-29","2025-03-14","2024-05-09","2024-11-11","2025-02-24","2025-02-24","2025-03-14","2025-03-24","2025-03-24","2025-03-24","2025-03-24","2025-03-24","2025-09-15","2025-10-13","2025-10-14","2025-10-14","2025-10-14","2025-10-14"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}