{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Senay Cinardere","gend":1,"currentgend":"","add":"118 PARKER ST","city":"SPRINGFIELD","state":"MA","zip":"01151","dob":"1985-10-11","age":"","mstatus":"","insh":"C0031874300","cliId":"","pno":"4133620203","cno":"","email":"","ename":"","eno":"","pphy":"Vidur S Singh","ppno":"4135943111","pcpadd":"444 Montgomery St, Adult I.M. Department","pcpcity":"Chicopee","pcpstate":"MA","pcpzip":"01020","pcpcounty":"","pcpid":"","pcpname":"Riverbend Medical Group,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"118 PARKER ST","madd2":"","madd3":"","mcity":"SPRINGFIELD","mstate":"MA","mzip":"01151","pcpfaxno":"","pcpnpi":"1154817377","currentgendcomment":"","pphycomment":"","uniqueid":"142339800","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","H60502","D751","Z0000","A048","Z23","E669","T7840XD","H538","M542","M546","R748","L299","L503","L2084","R7989","R5382","R5381","R140","R718","F17210","E66812","E6609","Z6838","Z1231","R0683","R093","M549","R1031","M79672","E119","J351","R200","E559","M25511","M5450","R935","E7800","R161","G8929","R0609","Z789","R0602","R196","M7910","M7551","M7541","M7542","S46011D","S46012D","R21","K449","E785"],"date":["2026-02-24","2026-05-29","2026-03-30","2026-03-30","2026-04-24","2025-08-13","2026-04-24","2025-08-13","2025-08-13","2025-10-23","2025-10-23","2025-08-07","2025-11-12","2025-11-12","2025-11-12","2026-04-24","2026-02-19","2026-02-05","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-02-27","2026-04-15","2024-08-01","2025-04-30","2024-08-14","2024-08-01","2024-08-01","2024-08-01","2024-08-01","2024-08-27","2025-03-11","2024-08-27","2024-09-17","2025-06-18","2024-11-01","2025-06-18","2024-09-30","2024-09-30","2024-09-30","2024-11-01","2024-11-19","2024-11-19","2025-03-11","2025-03-11","2025-03-11","2025-03-11","2025-06-18","2025-04-30","2025-05-01"],"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":[["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","DICLOFENAC POTASSIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","TETRACYCLINE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","RIFABUTIN","","","Select","Select",""],["","","CLARITHROMYCIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","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":""}]}]}