{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elliot Castellano","gend":0,"currentgend":"","add":"15 CHAPMAN AVE","city":"HOLYOKE","state":"MA","zip":"01040","dob":"1970-02-18","age":"","mstatus":"","insh":"C0034495600","cliId":"","pno":"5083331296","cno":"","email":"","ename":"","eno":"","pphy":"Nicholas  Felton","ppno":"4135368924","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":"","add3":"","madd1":"15 CHAPMAN AVE","madd2":"","madd3":"","mcity":"HOLYOKE","mstate":"MA","mzip":"01040","pcpfaxno":"","pcpnpi":"1457876542","currentgendcomment":"","pphycomment":"","uniqueid":"147221450","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","I2510","Z01810","Z01818","E1129","R809","G4733","M542","I10","E66812","E782","Z1339","Z125","M5416","Z1331","Z471","M25551","M25552","Z96643","R09A2","R0683","T783XXA","T464X5A","E6601","M436","R001","I6523","Z6835","M1811","E66811","Z6834","G5601","M189","R52","R1313","K1379","M25531","D369","M5414","M898X1","R0781","M25559","Z6836","Z7982","Z79899","M1990","E118","H43393","Q120","M25541","G5603","M1851","G4710","Z1211","Z860101","M25511"],"date":["2026-05-30","2026-03-05","2025-10-09","2025-10-09","2026-03-05","2026-03-05","2025-10-08","2025-11-06","2026-03-05","2026-03-05","2026-03-05","2026-03-05","2026-02-26","2026-03-05","2026-03-05","2026-04-13","2026-04-13","2026-04-13","2026-04-13","2025-07-25","2025-10-08","2025-07-25","2025-07-25","2025-07-25","2025-08-25","2025-10-09","2025-11-06","2025-12-01","2025-12-11","2026-03-05","2026-03-05","2025-06-06","2025-06-06","2025-06-06","2025-02-04","2025-03-31","2025-03-31","2025-04-22","2025-05-15","2025-05-15","2025-05-15","2025-04-28","2025-05-07","2025-05-07","2025-05-07","2025-02-04","2025-02-04","2025-02-27","2025-02-27","2025-04-16","2025-04-16","2025-04-16","2025-04-02","2025-04-22","2025-04-22","2025-05-15"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","ASPIRIN EC","","","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":""}]}]}