{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Hilary B Borgatti","gend":1,"currentgend":"","add":"25 CORAL AVE","city":"WINTHROP","state":"MA","zip":"02152","dob":"1985-08-26","age":"","mstatus":"","insh":"C0032904400","cliId":"","pno":6179704853,"cno":"","email":"","ename":"","eno":"","pphy":"Eileen Pierce","ppno":6175695800,"pcpadd":"20 Maverick Sq,","pcpcity":"East Boston","pcpstate":"MA","pcpzip":"02128","pcpcounty":"","pcpid":"","pcpname":"NeighborHealth Corporation","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 CORAL AVE","madd2":"","madd3":"","mcity":"WINTHROP","mstate":"MA","mzip":"02152","pcpfaxno":"","pcpnpi":1518176817,"currentgendcomment":"","pphycomment":"","uniqueid":144328350,"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","Z20828","R0789","K529","F410","F430","R200","R112","R0602","R1031","R202","R000","R309","R300","R350","R3915","R110","E119","J45909","Z556","Z749","N390","F411","R1084","H4711","Z6379","E6601","E1165","F3341","E66811","E6609","Z6833","E282","Z903","Z1389","Z6834","Z713","H52203","H5213","Z973"],"date":["2026-02-04","2025-02-06","2024-12-01","2024-12-01","2024-12-01","2024-12-01","2024-12-01","2024-12-01","2024-12-01","2024-12-01","2024-12-01","2024-12-01","2025-07-08","2025-07-08","2025-10-28","2025-07-08","2025-07-08","2025-10-30","2025-10-28","2025-07-08","2025-07-08","2025-10-28","2025-12-18","2024-08-28","2024-10-24","2024-11-07","2024-08-19","2026-01-16","2025-04-13","2026-01-16","2025-06-18","2025-06-18","2026-01-16","2026-01-16","2025-08-01","2025-08-01","2025-10-06","2025-10-30","2025-10-30","2025-10-30"],"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":[["","","DICYCLOMINE HCL","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","MOUNJARO","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}