{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sarah A Gonzalez","gend":1,"currentgend":"","add":"28 NORTHERN DR","city":"CHICOPEE","state":"MA","zip":"01013","dob":"1977-04-04","age":"","mstatus":"","insh":"C0005793700","cliId":"","pno":4138858877,"cno":"","email":"","ename":"","eno":"","pphy":"Anne Shain","ppno":4135987090,"pcpadd":"444 Montgomery St,","pcpcity":"Chicopee","pcpstate":"MA","pcpzip":"01020","pcpcounty":"","pcpid":"","pcpname":"Riverbend Medical Group,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 NORTHERN DR","madd2":"","madd3":"","mcity":"CHICOPEE","mstate":"MA","mzip":"01013","pcpfaxno":"","pcpnpi":1881657955,"currentgendcomment":"","pphycomment":"","uniqueid":65749250,"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","N3281","R079","J4520","J4530","F1290","Z720","R0602","Z8249","M79674","G8929","Z0000","Z1231","Z01419","N898","N393","R7303","E6601","Z6841","R7301","R928","Z23","F339","M7741","M7751","M2041","M79671","Z6839","M5450","E66812","Z6838","Z6837","E6609","Z6835","E66811","Z6834","Z6831","M79601","N760"],"date":["2025-12-19","2025-12-06","2024-11-03","2024-05-02","2024-08-04","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-03-27","2024-05-04","2024-05-04","2025-12-06","2024-08-04","2024-11-18","2024-09-07","2024-05-04","2025-10-04","2024-06-03","2024-06-03","2024-07-05","2024-07-05","2024-07-05","2024-07-05","2024-04-09","2024-09-23","2025-02-25","2024-10-29","2024-11-18","2025-09-09","2025-02-25","2025-09-09","2025-05-20","2025-09-09","2025-07-24","2024-07-04"],"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":[["","","VENTOLIN HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","PULMICORT FLEXHALER","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","NAPROXEN","","","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":""}]}]}