{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gisella Collazo","gend":1,"currentgend":"","add":"56 KENSINGTON AVE","city":"SPRINGFIELD","state":"MA","zip":"01108","dob":"1978-01-29","age":"","mstatus":"","insh":"C0025173100","cliId":"","pno":4133301152,"cno":"","email":"","ename":"","eno":"","pphy":"Sushma Gurung","ppno":4137391100,"pcpadd":"1049 Main St,","pcpcity":"Springfield","pcpstate":"MA","pcpzip":"01103","pcpcounty":"","pcpid":"","pcpname":"Caring Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"# 2","add3":"","madd1":"56 KENSINGTON AVE","madd2":"# 2","madd3":"","mcity":"SPRINGFIELD","mstate":"MA","mzip":"01108","pcpfaxno":"","pcpnpi":1043563653,"currentgendcomment":"","pphycomment":"","uniqueid":108421600,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","M722","Z6841","C50511","Z170","R5383","N921","R42","Z1231","Z853","Z9011","Z803","C50811","D0501","Z923","R928","C773","R635","D508","E669","Z6837","C50919","Z9010","Z1329","Z113","Z0000","Z23","Z124","Z1211","N951","Z1151","R7309","E66813","C50812","Z171","L989","C50911"],"date":["2025-10-28","2025-04-06","2025-09-04","2025-02-21","2025-03-14","2024-06-03","2024-10-06","2024-06-03","2025-03-14","2024-11-03","2024-11-06","2024-11-03","2025-09-04","2025-03-14","2025-09-04","2025-04-23","2024-03-21","2024-06-03","2024-10-06","2025-06-06","2024-11-06","2024-03-21","2024-11-03","2025-02-21","2025-02-21","2025-02-21","2025-02-21","2025-02-21","2025-02-21","2025-04-03","2025-04-03","2025-09-04","2025-04-14","2025-09-04","2025-09-04","2025-06-06","2025-01-23"],"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":[["","","TAMOXIFEN CITRATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ZEPBOUND","","","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":""}]}]}