{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wanda Burgos","gend":1,"currentgend":"","add":"10 CHESTNUT ST","city":"SPRINGFIELD","state":"MA","zip":"01103","dob":"1974-05-07","age":"","mstatus":"","insh":"C0034495800","cliId":"","pno":"4136573522","cno":"","email":"","ename":"","eno":"","pphy":"Tylor  Vaillancourt","ppno":"4134391100","pcpadd":"1049 Main St","pcpcity":"Springfield","pcpstate":"MA","pcpzip":"01103","pcpcounty":"","pcpid":"","pcpname":"Caring Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 1908","add3":"","madd1":"10 CHESTNUT ST","madd2":"APT 1908","madd3":"","mcity":"SPRINGFIELD","mstate":"MA","mzip":"01103","pcpfaxno":"","pcpnpi":"1255733127","currentgendcomment":"","pphycomment":"","uniqueid":"147221550","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N2889","F419","F32A","E119","I10","K219","E785","Z79899","Z603","Z1231","J069","J45909","I129","E1122","N189","Z803","Z8051","Z8249","Z833","Z1211","K648","T184XXA","Z85528","Z7951","Z7984","S29011A","D0919","D49512","Z23","J4530","R519","M5450","H66001","R311","Z3042","D4102","R897","Z01818","R197","R110","R0782","E1165","B351","M21619","Z905","C642","C649","Z3009","H9201","Z1151","Z01419","N281","K760","R42","R051","Z789","Z0000","F330","R2242","J302","Z780","N200","R99","R7303","E559","R109","R112"],"date":["2025-05-13","2025-11-18","2025-05-13","2026-02-10","2026-02-13","2025-12-02","2025-09-14","2025-12-02","2025-05-13","2025-06-30","2025-09-14","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-09-14","2025-09-14","2025-09-14","2025-09-14","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2024-12-05","2026-01-29","2025-05-19","2026-01-16","2026-02-14","2026-02-14","2025-01-14","2025-11-18","2025-02-05","2025-05-07","2025-02-11","2025-02-11","2025-03-10","2025-03-24","2025-03-24","2024-12-05","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2025-06-05","2025-06-17","2025-09-09","2025-06-17","2025-09-09","2025-09-09","2026-01-29","2025-01-22","2025-11-06","2025-11-06","2025-11-06","2025-11-18","2026-02-17","2026-01-16","2025-11-18","2026-01-16","2026-01-29","2026-02-14","2026-01-16","2025-02-11","2025-03-24","2025-03-24"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","BISACODYL","","","Select","Select",""],["","","COMBIPATCH","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MEDROXYPROGESTERONE ACETATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","TERBINAFINE HCL","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}