{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Arlene M Hanafin","gend":1,"currentgend":"","add":"4925 WASHINGTON ST","city":"WEST ROXBURY","state":"MA","zip":"02132","dob":"1963-07-05","age":"","mstatus":"","insh":"C0030518200","cliId":"","pno":6172122055,"cno":"","email":"","ename":"","eno":"","pphy":"Julian R Gonzalez","ppno":6173234440,"pcpadd":"4199 Washington St,","pcpcity":"Roslindale","pcpstate":"MA","pcpzip":"02131","pcpcounty":"","pcpid":"","pcpname":"Boston Medical Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 211","add3":"","madd1":"4925 WASHINGTON ST","madd2":"APT 211","madd3":"","mcity":"WEST ROXBURY","mstate":"MA","mzip":"02132","pcpfaxno":"","pcpnpi":1861996134,"currentgendcomment":"","pphycomment":"","uniqueid":139819300,"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","F32A","S90464A","Z6833","E6601","J4520","E669","Z713","R7303","K760","E785","I10","I2510","Z6832","L720","L988","F320","E6609","Z124","Z6837","K5903","Z122","R1013","A071","E66811","Z1231","M25511","E66812","Z7182","Z6835","S46011D","R197","Z1211","R051","M7541","F411","F339","F3341","F3340","Z87891","R946","M67911","S46091D","H9202","H60332"],"date":["2026-02-25","2025-04-22","2024-07-15","2024-12-24","2024-09-23","2025-12-08","2024-05-01","2025-09-15","2025-10-31","2025-10-31","2024-04-16","2025-10-31","2025-09-15","2024-05-01","2024-06-14","2024-06-14","2024-06-14","2026-01-26","2024-09-23","2024-09-23","2024-09-13","2025-10-31","2024-12-06","2024-12-24","2026-02-02","2025-06-03","2026-01-07","2026-01-26","2025-09-15","2026-01-26","2026-01-20","2025-10-31","2025-11-23","2025-12-08","2026-01-07","2025-06-11","2025-02-24","2025-04-16","2025-06-11","2024-10-28","2024-10-28","2025-06-03","2026-01-05","2025-08-11","2025-08-11"],"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":[["","","NALTREXONE HCL","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ASPIRIN","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","GUAIFENESIN-CODEINE","","","Select","Select",""],["","","BENZONATATE","","","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":""}]}]}