{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Greichny A Florimon Moya","gend":1,"currentgend":"","add":"54 BRADFORD DR","city":"W SPRINGFIELD","state":"MA","zip":"01089","dob":"1978-06-07","age":"","mstatus":"","insh":"C0034478300","cliId":"","pno":"6177927993","cno":"","email":"","ename":"","eno":"","pphy":"Maurice  Turner","ppno":"4135354800","pcpadd":"2 Hospital Dr, Ste 101","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":"APT A3","add3":"","madd1":"54 BRADFORD DR","madd2":"APT A3","madd3":"","mcity":"W SPRINGFIELD","mstate":"MA","mzip":"01089","pcpfaxno":"","pcpnpi":"1881426328","currentgendcomment":"","pphycomment":"","uniqueid":"147175950","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","E042","R194","N946","F32A","F419","E7800","D219","G4700","E079","R7989","K2970","Z1231","R1013","N939","R350","R112","Z01419","Z113","Z202","Z1211","Z114","Z1159","Z118","Z1151","D259","Z3202","A048","Z79899","R45851","R002","R21","L2989","L299","Z30433","Z30431","M25512","K120","K1370","H938X1","B370","K219","K5730","K648","K635","F331","F411","F4389","E041","D251","F428","Z30430","J029","Z1152","Z0000","R109","K6289","R070"],"date":["2026-05-14","2026-04-03","2026-05-07","2025-08-26","2026-04-03","2026-04-03","2026-04-03","2026-01-02","2026-01-02","2026-01-02","2025-08-26","2026-05-07","2025-10-10","2026-05-07","2026-05-13","2025-08-13","2026-05-07","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2026-05-13","2026-03-25","2025-12-15","2025-12-15","2026-04-03","2026-01-02","2026-01-02","2026-04-03","2026-01-02","2026-02-06","2026-03-25","2026-04-03","2026-04-03","2026-05-01","2026-05-01","2026-05-01","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-04-24","2026-04-24","2026-04-24","2025-08-20","2025-10-02","2026-04-24","2026-02-06","2025-01-01","2025-01-01","2025-05-30","2025-05-21","2025-04-30","2025-01-01"],"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":[["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","GAVILYTE-G","","","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":""}]}]}