{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Austin Pellegrino","gend":0,"currentgend":"","add":"3 CHERYL LN","city":"SOUTHAMPTON","state":"MA","zip":"01073","dob":"1988-03-26","age":"","mstatus":"","insh":"C0034022100","cliId":"","pno":5089819800,"cno":"","email":"","ename":"","eno":"","pphy":"Kharmen Lopez del Castillo","ppno":4135299300,"pcpadd":"238 Northampton St,","pcpcity":"Easthampton","pcpstate":"MA","pcpzip":"01027","pcpcounty":"","pcpid":"","pcpname":"Valley Medical Group, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 22","madd2":"","madd3":"","mcity":"SOUTHWICK","mstate":"MA","mzip":"01077","pcpfaxno":"","pcpnpi":1861600934,"currentgendcomment":"","pphycomment":"","uniqueid":146394200,"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":["I10","B356","J029","R220","F419","L03213","J302","B351","R99","J020","M26629","F411","M79671","M25561","R21","F17210","F17200","J069","Z113","U071","H0014","Z23","Z2820","L603","Z7729","N5089","Z7289","R051","F17290","R070","G4700","M25569","F5104","Z1331","Z131"],"date":["2025-12-15","2024-12-26","2025-08-27","2025-01-13","2025-01-18","2025-02-06","2025-03-18","2025-03-21","2026-02-02","2025-05-27","2025-09-05","2025-09-05","2025-09-08","2026-02-24","2024-12-03","2025-12-15","2025-05-27","2025-01-13","2025-01-02","2025-10-02","2025-02-06","2025-12-15","2025-03-18","2025-03-18","2025-03-18","2025-04-07","2025-09-05","2025-05-27","2025-08-27","2025-09-03","2025-09-05","2025-09-05","2025-12-15","2025-12-15","2025-12-15"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","ZALEPLON","","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","","","Select","Select",""],["","","LIDOCAINE","","","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":""}]}]}