{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laura J Gaj","gend":1,"currentgend":"","add":"220 Taylor Street","city":"Granby","state":"MA","zip":"01033","dob":"1964-01-06","age":"","mstatus":"","insh":"C0001391801","cliId":"","pno":4132057659,"cno":"","email":"","ename":"","eno":"","pphy":"Joanna Cichon","ppno":4135354800,"pcpadd":"1962 Memorial Dr,","pcpcity":"Chicopee","pcpstate":"MA","pcpzip":"01020","pcpcounty":"","pcpid":"","pcpname":"Western Mass Physician Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"220 Taylor Street","madd2":"","madd3":"","mcity":"Granby","mstate":"MA","mzip":"01033","pcpfaxno":"","pcpnpi":1891768529,"currentgendcomment":"","pphycomment":"","uniqueid":56664251,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S1086XA","M329","Z9221","I2510","E785","E7800","Z87891","Z7982","I7121","Z8249","Z0000","M25562","D72819","S41151A","W540XXA","Z1231","S71151A","S51851D","W540XXD","S71151D","T6391XA","R079","I77810","Z79899","N3090","R1032","N200","Z1211","Z1212","R200","N399","E538","M7989","D2239","L821","D225","D2261","L810","L292","L820","Z8679","M79652","L988","S31106A","W57XXXA","R99","S40811A","Z23","I7120","Z03818","D509","Z712"],"date":["2025-10-31","2025-12-03","2025-10-31","2025-12-03","2025-11-25","2025-09-12","2025-09-12","2025-09-12","2025-07-30","2024-02-20","2025-12-03","2024-02-26","2024-02-26","2024-04-15","2024-04-15","2024-03-29","2024-04-13","2024-04-29","2024-04-29","2024-04-29","2024-04-13","2025-09-12","2024-05-23","2024-12-30","2024-06-24","2024-07-31","2024-07-31","2024-06-20","2024-06-20","2024-09-08","2025-10-31","2025-12-03","2024-04-13","2025-09-30","2025-09-30","2025-09-30","2025-09-30","2025-09-30","2025-06-25","2025-09-30","2025-01-07","2025-08-25","2025-10-25","2025-10-25","2025-10-31","2025-12-24","2024-04-13","2024-04-13","2024-06-05","2024-09-08","2024-12-27","2025-07-30"],"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":[["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BRILINTA","","","Select","Select",""],["","","LEVOFLOXACIN","","","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":""}]}]}