{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David Levin","gend":0,"currentgend":"","add":"153 S TALLYHO DR","city":"SPRINGFIELD","state":"MA","zip":"01118","dob":"1977-06-11","age":"","mstatus":"","insh":"C0001846700","cliId":"","pno":4135194863,"cno":"","email":"","ename":"","eno":"","pphy":"Cyril Joseph","ppno":4137348254,"pcpadd":"175 Carew St,Ste 200","pcpcity":"Springfield","pcpstate":"MA","pcpzip":"01104","pcpcounty":"","pcpid":"","pcpname":"Riverbend Medical Group,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 AMERICA ST","madd2":"F","madd3":"","mcity":"Chicopee","mstate":"MA","mzip":"01013","pcpfaxno":"","pcpnpi":1720156615,"currentgendcomment":"","pphycomment":"","uniqueid":57314200,"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":["Z01818","I10","E119","E7800","Z794","E1140","M79671","R600","L853","M79672","E113392","K219","K222","Z1211","K2970","K269","K2950","Z961","H25813","E113313","H35373","H40052","E113391","I739","E1142","E782","E66811","H25811","H25812","H35352","H35371","E113393","G4733","M75121","E1129","R99","E1149","R059","J45991","G629","M7501","M7502","I517","E785","Z7984","Z7985","Z79899","Z885","M25511","M25512","G8929","Z0000","E669","F419","F32A","Z6833","B353","M79674","E1165","M79675","E113312","R809","G4734","R011","R0982","M7551","M75101","I7389","I422","I159","H25042","L97412","Z1212","E113311"],"date":["2025-05-13","2025-11-02","2025-05-13","2025-05-13","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-08-20","2025-10-23","2025-10-15","2025-04-21","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-06-23","2025-05-06","2025-11-08","2025-11-08","2025-11-08","2025-11-08","2025-10-20","2025-12-27","2025-10-23","2025-02-10","2025-06-26","2025-06-23","2025-06-23","2025-06-23","2025-06-23","2025-07-05","2024-10-23","2025-12-25","2025-11-19","2024-11-17","2024-09-13","2025-01-25","2025-04-01","2024-10-04","2024-10-04","2025-01-23","2025-07-01","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2024-04-29","2024-10-23","2024-05-09","2025-01-04","2024-07-03","2024-07-03","2024-07-03","2024-07-03","2024-10-16","2024-10-16","2024-10-16","2024-10-16","2024-11-03","2025-07-01","2024-04-25","2024-04-25","2024-04-30","2024-05-13","2024-05-09","2024-10-14","2025-07-05","2025-07-01","2025-03-03","2025-04-14","2025-04-21","2025-04-28"],"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":[["","","OZEMPIC","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","DIVALPROEX SODIUM","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","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":""}]}]}