{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan Gilpatrick","gend":1,"currentgend":"","add":"7 AMHERST ST","city":"GRANBY","state":"MA","zip":"01033","dob":"1963-05-19","age":"","mstatus":"","insh":"C0000730900","cliId":"","pno":4133642348,"cno":"","email":"","ename":"","eno":"","pphy":"Annabel C Espinas","ppno":4135354800,"pcpadd":"1962 Memorial Dr,","pcpcity":"Chicopee","pcpstate":"MA","pcpzip":"01020","pcpcounty":"","pcpid":"","pcpname":"Western Mass Physician Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 AMHERST ST","madd2":"","madd3":"","mcity":"GRANBY","mstate":"MA","mzip":"01033","pcpfaxno":"","pcpnpi":1518918770,"currentgendcomment":"","pphycomment":"","uniqueid":55737100,"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":["Z1231","M4722","M25561","M1711","M47812","M5481","I10","R99","Z01419","M542","M5020","M532X2","G8929","J302","Z79899","Z87891","Z98890","Z981","M961","Z0001","F411","J3089","J4520","Z7189","M4312","M5030","M50221","M9971","Z01810","M50122","Z0000"],"date":["2025-07-11","2025-12-04","2025-09-25","2025-09-25","2025-12-31","2025-12-31","2025-06-27","2026-02-06","2024-04-12","2025-08-07","2024-09-13","2024-12-19","2025-09-19","2024-12-19","2024-12-19","2024-12-19","2024-12-19","2025-02-21","2025-08-07","2025-05-01","2025-06-27","2025-05-01","2025-05-01","2025-05-01","2024-12-19","2024-09-13","2024-09-13","2024-09-13","2024-12-13","2024-10-04","2025-05-01"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","GABAPENTIN","","","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":""}]}]}