{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn L Holland","gend":1,"currentgend":"","add":"500 PLAINFIELD ST","city":"SPRINGFIELD","state":"MA","zip":"01107","dob":"1962-02-18","age":"","mstatus":"","insh":"C0020303200","cliId":"","pno":4134557308,"cno":"","email":"","ename":"","eno":"","pphy":"Elias Name","ppno":4134202107,"pcpadd":"230 Maple St,P.O Box 6260","pcpcity":"Holyoke","pcpstate":"MA","pcpzip":"01040","pcpcounty":"","pcpid":"","pcpname":"Holyoke Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"500 PLAINFIELD ST","madd2":"APT 2","madd3":"","mcity":"SPRINGFIELD","mstate":"MA","mzip":"01107","pcpfaxno":"","pcpnpi":1881664134,"currentgendcomment":"","pphycomment":"","uniqueid":99149100,"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":["M1611","Q6589","I10","E785","E039","Z79890","Z79899","Z87891","T84020A","R519","M25561","R0989","D649","K219","F319","Z791","Z7982","S73034D","Z96641","M1612","S0101XA","S0990XA","Z122","Z23","N2581","M25551","Z9884","M25552","G8929","H26492","H353131","M160","K08109","Z720","R2681","F17200","R7989","Z01818","Z01812","Z131","Z471","M1631","Z98890","S73034A","Z7901","F17201","W19XXXA","R99","F419","N898","H6691","R5383","M5383","S73044D","R030","R635","Z96642","M67252","M67852","F5104","Z2821","Z5320","Z09","F0781","S0101XD","Z9181","R52"],"date":["2025-06-03","2025-06-03","2026-02-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-06-23","2025-06-23","2025-06-23","2025-06-23","2025-06-23","2025-06-23","2026-02-24","2025-11-25","2025-06-23","2025-08-20","2025-11-13","2025-09-22","2025-11-25","2025-11-25","2024-10-19","2025-02-24","2025-04-14","2025-06-22","2025-09-10","2025-05-27","2025-05-27","2025-04-15","2025-03-14","2025-03-20","2025-03-20","2025-05-09","2025-03-20","2025-09-03","2025-04-14","2025-09-12","2025-09-10","2025-05-29","2025-09-22","2025-06-03","2025-07-02","2025-06-23","2025-06-21","2025-06-22","2025-06-22","2026-02-18","2025-07-03","2025-07-19","2025-07-19","2025-02-24","2025-02-24","2025-07-14","2025-07-14","2025-09-10","2025-10-08","2025-09-22","2025-09-22","2025-11-13","2025-11-13","2025-11-13","2025-12-04","2025-12-04","2025-12-04","2025-12-04","2025-06-21"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CHLORTHALIDONE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}