{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean Blondek","gend":1,"currentgend":"","add":"17 BERWYN ST","city":"SOUTH HADLEY","state":"MA","zip":"01075","dob":"1965-05-12","age":"","mstatus":"","insh":"C0027382800","cliId":"","pno":"4134933943","cno":"","email":"","ename":"","eno":"","pphy":"Lorenver  Po","ppno":"4135368924","pcpadd":"2 Hospital Dr","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":"","add3":"","madd1":"17 BERWYN ST","madd2":"","madd3":"","mcity":"SOUTH HADLEY","mstate":"MA","mzip":"01075","pcpfaxno":"","pcpnpi":"1164422432","currentgendcomment":"","pphycomment":"","uniqueid":"132717400","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":["Z1211","R99","I10","D510","M65331","Z1231","D126","R140","R748","Z01818","Z860101","K648","D120","K5730","Z0000","E7800","E663","C439","F411","R0789","E538","G5601","R7989","K635","K5790","K6289","Z6826","Z85820","L718","Z0001","Z01419","R112","Z79899","L821","D224","D2239","D225","Z08","Z7189","L820","L538","R208"],"date":["2025-11-10","2025-12-17","2026-03-31","2026-03-05","2026-03-31","2025-07-21","2025-09-10","2025-09-10","2025-09-10","2025-09-10","2025-11-10","2025-11-10","2025-11-10","2025-11-10","2026-02-16","2026-03-04","2026-02-16","2026-02-16","2026-02-16","2026-02-16","2026-05-04","2026-03-31","2026-04-27","2025-11-10","2025-11-10","2025-11-10","2026-02-16","2026-02-16","2025-05-23","2024-10-09","2024-09-17","2024-12-31","2024-12-31","2024-08-14","2024-08-14","2024-08-14","2024-08-14","2024-08-14","2024-08-14","2024-08-14","2024-08-14","2024-08-14"],"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":[["","","METRONIDAZOLE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","CYANOCOBALAMIN INJECTION","","","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":""}]}]}