{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paola D Diaz Adorno","gend":1,"currentgend":"","add":"444 BELMONT AVE","city":"SPRINGFIELD","state":"MA","zip":"01108","dob":"2001-10-02","age":"","mstatus":"","insh":"C0032638500","cliId":"","pno":"4137770512","cno":"","email":"","ename":"","eno":"","pphy":"Purnima S Adlakha","ppno":"4135328700","pcpadd":"10 Hospital Dr, Ste 311","pcpcity":"Holyoke","pcpstate":"MA","pcpzip":"01040","pcpcounty":"","pcpid":"","pcpname":"Purnima S. Adlakha, M.D","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"# 1","add3":"","madd1":"444 BELMONT AVE","madd2":"# 1","madd3":"","mcity":"SPRINGFIELD","mstate":"MA","mzip":"01108","pcpfaxno":"","pcpnpi":"1487601175","currentgendcomment":"","pphycomment":"","uniqueid":"143773950","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":["R99","J101","J069","J45909","Z20822","Z7951","J4541","Z79899","F4310","J0190","J209","Z0000","R42","R634","Z113","J4540","Z6820","R0600","R0602","E876"],"date":["2026-02-24","2026-01-05","2025-05-26","2025-05-26","2025-05-26","2025-05-26","2025-04-07","2025-04-07","2025-04-22","2025-02-19","2025-02-19","2025-04-21","2025-04-21","2025-04-21","2025-04-21","2025-05-28","2025-05-28","2025-05-26","2025-04-07","2025-04-07"],"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":[["","","FLUOXETINE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","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":""}]}]}