{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Samuel Moure","gend":0,"currentgend":"","add":"11 ORLANDO ST","city":"FEEDING HILLS","state":"MA","zip":"01030","dob":"1985-02-25","age":"","mstatus":"","insh":"C0009983800","cliId":"","pno":4135356341,"cno":"","email":"","ename":"","eno":"","pphy":"Sowmya Reddy Thadisina","ppno":4137896800,"pcpadd":"230 Main St,","pcpcity":"Agawam","pcpstate":"MA","pcpzip":"01001","pcpcounty":"","pcpid":"","pcpname":"Riverbend Medical Group,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 ORLANDO ST","madd2":"","madd3":"","mcity":"FEEDING HILLS","mstate":"MA","mzip":"01030","pcpfaxno":"","pcpnpi":1972793370,"currentgendcomment":"","pphycomment":"","uniqueid":69387750,"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","I10","R051","S86911A","K219","R109","K2900","K449","J069","F419","R002","M25561","Z87828","G43109","G8929","M2391","M1120","S83511S","R9431","Z0000","E66811","E781","Z6832","K5792","N3289","Z136","Z130","Z13220","Z1159","G43809","E782","R1012","R1032","R0782"],"date":["2025-12-15","2025-10-14","2024-04-25","2025-01-08","2025-12-17","2025-02-22","2025-02-22","2025-02-22","2024-04-25","2024-12-07","2025-01-17","2024-12-07","2024-12-07","2024-12-07","2024-12-07","2024-07-22","2024-07-22","2024-07-22","2024-11-20","2024-04-12","2024-04-12","2024-04-12","2024-04-12","2025-02-22","2025-02-22","2025-03-21","2025-03-21","2025-03-21","2025-03-21","2025-09-23","2025-09-23","2025-09-23","2025-10-17","2025-06-11"],"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":[["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","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":""}]}]}