{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Chaowalit Dechanupong","gend":0,"currentgend":"","add":"114A HAWLEY ST","city":"NORTHAMPTON","state":"MA","zip":"01060","dob":"1963-11-10","age":"","mstatus":"","insh":"C0012811401","cliId":"","pno":"4133295000","cno":"","email":"","ename":"","eno":"","pphy":"Chalice M Santorelli","ppno":"4135842178","pcpadd":"22 Atwood Dr, Ste 201","pcpcity":"Northampton","pcpstate":"MA","pcpzip":"01060","pcpcounty":"","pcpid":"","pcpname":"CD Practice Associates, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"114A HAWLEY ST","madd2":"","madd3":"","mcity":"NORTHAMPTON","mstate":"MA","mzip":"01060","pcpfaxno":"","pcpnpi":"1972773117","currentgendcomment":"","pphycomment":"","uniqueid":"79782151","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","Z0001","R7303","E7800","R059","R1013","R140","Z800","I10","M5441","H9313","Z7185","H40031","H40032","Z1211","K5730","K6389","K2270","S8265XD","S82899A","J069","R12","R0789","D563","J209","L509","R053","H40033","H40062","H40061"],"date":["2025-12-13","2025-06-09","2025-10-07","2025-10-07","2025-09-08","2025-09-08","2025-12-09","2025-12-09","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2025-11-12","2025-11-05","2025-12-09","2025-12-09","2025-12-09","2025-12-09","2025-04-08","2025-04-08","2025-05-29","2025-06-18","2025-04-01","2025-04-01","2025-06-18","2025-07-29","2025-09-08","2025-10-28","2025-11-05","2025-11-12"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","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":""}]}]}