{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Todd Guenther","gend":0,"currentgend":"","add":"134 COLLEGE ST","city":"SOUTH HADLEY","state":"MA","zip":"01075","dob":"1964-06-28","age":"","mstatus":"","insh":"C0004364400","cliId":"","pno":4135363750,"cno":"","email":"","ename":"","eno":"","pphy":"Antone Cruz","ppno":4135987090,"pcpadd":"444 Montgomery St,","pcpcity":"Chicopee","pcpstate":"MA","pcpzip":"01020","pcpcounty":"","pcpid":"","pcpname":"Riverbend Medical Group,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"134 COLLEGE ST","madd2":"APT 1","madd3":"","mcity":"SOUTH HADLEY","mstate":"MA","mzip":"01075","pcpfaxno":"","pcpnpi":1851354716,"currentgendcomment":"","pphycomment":"","uniqueid":63032250,"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","L718","N200","R39198","Z1211","K640","Z881","Z888","Z79899","L400","L738","L821","A630","L218","M9901","M9903","M9905","M9902","L720","R918","I10","E785","C61","R7309","M549","G8929","M79641","M79642","D225","Z0100","H0013","N529","Z8546","J029","R220","M180","Z0389","M5126","Z7189","R911","M25552","M6249","B078","H43812","H43811","H2513","M25521","M25522","D3132","M5450","R109","M47816"],"date":["2025-12-12","2025-10-21","2025-10-06","2024-10-06","2025-05-21","2025-05-21","2025-05-21","2025-05-21","2025-06-05","2025-10-21","2025-10-21","2025-10-21","2024-03-26","2025-10-21","2025-12-09","2024-09-09","2025-12-09","2024-09-09","2024-05-29","2024-04-18","2025-08-20","2025-08-20","2024-10-07","2024-10-07","2025-11-17","2025-11-17","2024-08-23","2024-08-23","2025-10-21","2024-10-07","2024-07-17","2025-08-20","2025-11-17","2024-08-23","2024-09-10","2024-04-10","2024-10-06","2025-11-17","2024-12-30","2025-11-17","2025-12-09","2025-12-09","2025-04-14","2025-04-28","2025-04-28","2025-04-28","2025-06-05","2025-06-05","2025-01-07","2025-06-26","2025-06-26","2025-11-17"],"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",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ZORYVE","","","Select","Select",""],["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","DESONIDE","","","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":""}]}]}