{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alexis Klinker","gend":1,"currentgend":"","add":"79 HITCHCOCK ST","city":"HOLYOKE","state":"MA","zip":"01040","dob":"1997-06-17","age":"","mstatus":"","insh":"C0037849000","cliId":"","pno":"6032838607","cno":"","email":"","ename":"","eno":"","pphy":"Sanjana S Pai","ppno":"4134222200","pcpadd":"230 Maple St","pcpcity":"Holyoke","pcpstate":"MA","pcpzip":"01040","pcpcounty":"","pcpid":"","pcpname":"Holyoke Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"# 2","add3":"","madd1":"79 HITCHCOCK ST","madd2":"# 2","madd3":"","mcity":"HOLYOKE","mstate":"MA","mzip":"01040","pcpfaxno":"","pcpnpi":"1457580953","currentgendcomment":"","pphycomment":"","uniqueid":"151920250","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","O24414","O99891","R030","O09292","Z3A22","Z3482","R7309","R350","O0993","O24424","Z370","O26893","O134","O324XX0","O721","O76","Z3A39","O99345","F418","O9081","Z3492","O24419","O24410","Z23","O24913","Z3A34","Z3A33","O368930","Z3A35","O162","Z3A37","Z3689","Z3A38","O629","O165","Z8632","Z391","Z114","Z3401","Z1159","Z124","O99340","F419","O26892","R109","R110","Z3A15","R748","Z3687","O3680X0","Z3A10","Z360","Z3A20"],"date":["2026-04-27","2025-10-31","2025-07-09","2025-07-09","2025-07-09","2025-07-09","2025-09-11","2025-08-19","2025-09-11","2025-11-05","2025-11-03","2025-11-05","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2025-11-05","2026-04-27","2026-04-27","2026-04-16","2025-07-09","2025-08-26","2025-09-03","2025-09-24","2025-10-28","2025-09-30","2025-09-24","2025-09-30","2025-10-07","2025-10-17","2025-10-21","2025-10-31","2025-10-28","2025-11-05","2025-11-10","2026-03-19","2025-11-07","2025-04-16","2025-05-13","2025-04-16","2025-04-16","2025-05-13","2025-05-13","2025-05-15","2025-05-15","2025-05-15","2025-05-15","2025-06-18","2025-04-16","2025-04-16","2025-04-16","2025-04-16","2025-06-24"],"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":[["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","NOVOLIN N FLEXPEN","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","SERTRALINE 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":[]}},{"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":""}]}]}