{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joselyn M Santos","gend":1,"currentgend":"","add":"40 MUELLER RD","city":"HOLYOKE","state":"MA","zip":"01040","dob":"1995-01-13","age":"","mstatus":"","insh":"C0031060200","cliId":"","pno":"4134740549","cno":"","email":"","ename":"","eno":"","pphy":"Alexxis  Washington","ppno":"4134202200","pcpadd":"230 Maple St","pcpcity":"Holyoke","pcpstate":"MA","pcpzip":"01040","pcpcounty":"","pcpid":"","pcpname":"Holyoke Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"40 MUELLER RD","madd2":"","madd3":"","mcity":"HOLYOKE","mstate":"MA","mzip":"01040","pcpfaxno":"","pcpnpi":"1710710496","currentgendcomment":"","pphycomment":"","uniqueid":"140684800","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":["R051","M25531","M25532","G5632","N83202","D271","N83292","F411","F331","F900","F4310","J3089","J4540","T40715D","L508","Z113","Z114","Z1159","H43393","H11133","J4530","R99","G43E09","Z01419","Z7689","R1020","Z8742","N736","J45909","Z91018","Z87891","Z7951","F32A","Z0182","R102","I872","L7211","Z0000","G5622","N83291","J45901"],"date":["2025-12-19","2026-03-16","2026-03-16","2026-03-16","2026-02-06","2026-02-06","2026-02-06","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-03-16","2026-03-20","2026-03-16","2026-03-16","2026-04-03","2026-04-03","2026-04-03","2026-04-23","2026-04-23","2026-03-15","2026-02-06","2026-05-06","2025-09-11","2025-09-06","2025-10-30","2025-10-30","2026-02-06","2026-02-06","2026-02-06","2026-02-06","2026-02-06","2025-11-01","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-09-11","2025-10-14","2025-10-30","2024-11-08"],"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":[["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","NAPROXEN","","","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":""}]}]}