{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christian J Bonilla Hernandez","gend":0,"currentgend":"","add":"12 Royce Court","city":"West Springfield","state":"MA","zip":"01089","dob":"1986-03-27","age":"","mstatus":"","insh":"C0008165800","cliId":"","pno":"4137773237","cno":"","email":"","ename":"","eno":"","pphy":"Nicholas  Felton","ppno":"4135368924","pcpadd":"2 Hospital Dr, Ste 101","pcpcity":"Holyoke","pcpstate":"MA","pcpzip":"01040","pcpcounty":"","pcpid":"","pcpname":"Western Mass Physician Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"B4","add3":"","madd1":"12 Royce Court","madd2":"B4","madd3":"","mcity":"West Springfield","mstate":"MA","mzip":"01089","pcpfaxno":"","pcpnpi":"1457876542","currentgendcomment":"","pphycomment":"","uniqueid":"67367500","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","E1022","E1021","R809","I10","E785","N184","Z9641","I129","Z87891","E875","E66811","B351","Z23","Z6833","Z79899","E10319","Z6835","Z139","T63441A","H25813","E103293","Q1389","H11153","H02831","H02834","H527","Z0000","E1065","Z833","Z4681","Z794","R052","Z6834","H16223","H5213","H2513","E119"],"date":["2026-04-23","2026-05-02","2026-05-11","2025-08-20","2025-08-20","2026-05-11","2026-05-11","2026-02-27","2026-05-11","2026-01-02","2026-05-11","2026-02-27","2025-11-11","2025-11-11","2025-11-11","2026-03-06","2026-02-27","2026-02-27","2025-08-25","2025-08-22","2026-04-06","2026-04-06","2026-04-06","2026-04-06","2026-04-06","2026-04-06","2026-04-06","2026-05-11","2024-07-24","2024-07-24","2025-05-14","2025-02-19","2025-05-05","2025-05-05","2025-02-19","2025-02-19","2025-02-19","2025-02-19"],"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":[["","","NIFEDIPINE ER","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","SPS","","","Select","Select",""],["","","HUMALOG","","","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":""}]}]}