{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Luz M Quintana","gend":1,"currentgend":"","add":"1093 PARKER ST","city":"SPRINGFIELD","state":"MA","zip":"01129","dob":"1965-04-22","age":"","mstatus":"","insh":"C0030499300","cliId":"","pno":"4137777281","cno":"","email":"","ename":"","eno":"","pphy":"Fhamida  Khan","ppno":"4137348254","pcpadd":"175 Carew St, Ste 200","pcpcity":"Springfield","pcpstate":"MA","pcpzip":"01104","pcpcounty":"","pcpid":"","pcpname":"Riverbend Medical Group,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1093 PARKER ST","madd2":"","madd3":"","mcity":"SPRINGFIELD","mstate":"MA","mzip":"01129","pcpfaxno":"","pcpnpi":"1013575026","currentgendcomment":"","pphycomment":"","uniqueid":"139809850","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":["Z91018","R99","R1084","I10","N289","Z0000","R1011","Z1231","N6325","R92322","R42","H9313","R5383","Z13220","R7309","E559","E669","Z136","Z6829","R109","R030","E782","K219","N6489","R079","I159","Z79899","Z7982","Z91148","R531","L821","D2239","D224","D225","D2262","D2261","D2260","D2271","G4733"],"date":["2025-09-24","2025-10-20","2025-09-20","2026-03-23","2025-09-24","2025-09-23","2025-10-20","2025-09-23","2025-10-27","2025-10-27","2026-03-23","2026-03-23","2025-09-08","2025-09-08","2025-09-08","2025-10-20","2025-09-08","2025-09-08","2025-09-24","2025-09-20","2025-10-20","2025-10-20","2025-10-20","2025-10-27","2026-03-23","2025-05-31","2025-06-30","2025-05-31","2025-05-27","2025-05-27","2024-11-19","2024-11-19","2024-11-19","2024-11-19","2024-11-19","2024-11-19","2024-11-19","2024-11-19","2025-05-29"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DILTIAZEM 12HR ER","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","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":""}]}]}