{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Damaris Irizarry","gend":1,"currentgend":"","add":"200 MAPLE ST","city":"SPRINGFIELD","state":"MA","zip":"01105","dob":"1967-09-22","age":"","mstatus":"","insh":"C0007412100","cliId":"","pno":"4135753960","cno":"","email":"","ename":"","eno":"","pphy":"Lina M Parra Jaramillo","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":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"200 MAPLE ST","madd2":"","madd3":"","mcity":"SPRINGFIELD","mstate":"MA","mzip":"01105","pcpfaxno":"","pcpnpi":"1871155937","currentgendcomment":"","pphycomment":"","uniqueid":"66820300","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","I10","J4540","L239","L218","R051","J209","L234","R21","L299","Z7951","Z79899","Z8616","B09","B9789","K219","J45909","E041","K5900","Z7952","G43109","M542","K222","K2100","Z1231","L249","I8390","I8393","R1013","N898","Z113","L243","Z7689","R3129","J301","L209","R350","H43393","H04123","K2080","Z98890","K5909","R232","N83201","H11042","H11151","H18413","H02831","H02834","H524","Z0000","M25511","M47812","R102","L300","D224","D2239","D225","D2261","N951","R29898","G8929","J069","J4541","H1031","M19011","M67911","M62838","J3089","J3081","Z79890","M5412","M50222","M531","M7918"],"date":["2026-05-23","2026-03-27","2026-03-12","2025-12-30","2025-12-30","2026-03-12","2026-03-12","2025-10-27","2025-10-27","2025-11-19","2025-10-31","2025-10-31","2025-10-27","2025-11-19","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2025-10-20","2025-10-20","2025-11-20","2025-11-20","2025-12-08","2025-09-04","2025-09-04","2025-09-04","2025-09-18","2025-10-01","2025-10-01","2025-11-19","2025-11-19","2026-01-14","2026-03-12","2026-03-12","2026-01-14","2026-04-14","2026-04-14","2026-02-03","2026-02-03","2026-02-03","2026-03-16","2026-03-16","2026-04-14","2026-04-14","2026-04-14","2026-04-14","2026-04-14","2026-04-14","2025-06-23","2024-10-16","2025-06-09","2025-06-10","2024-07-15","2024-07-15","2024-07-15","2024-07-15","2024-07-15","2024-08-26","2024-09-13","2024-09-13","2024-09-19","2024-09-19","2024-09-19","2024-10-16","2024-09-13","2024-10-16","2024-12-09","2024-12-09","2024-12-23","2025-01-24","2025-01-23","2025-06-09","2025-05-09"],"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":[["","","MELOXICAM","","","Select","Select",""],["","","ESTRADIOL (TWICE WEEKLY)","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","EMGALITY PEN","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ESTRING","","","Select","Select",""],["","","ASMANEX HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","DULERA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PROGESTERONE","","","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":""}]}]}