{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bruce W Bergeron","gend":0,"currentgend":"","add":"62 CRAIG DR","city":"W SPRINGFIELD","state":"MA","zip":"01089","dob":"1966-11-16","age":"","mstatus":"","insh":"C0006544600","cliId":"","pno":4136939900,"cno":"","email":"","ename":"","eno":"","pphy":"Nicholas Felton","ppno":4135368924,"pcpadd":"2 Hospital Dr,Ste 101","pcpcity":"Holyoke","pcpstate":"MA","pcpzip":"01040","pcpcounty":"","pcpid":"","pcpname":"Western Mass Physician Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"APT 7D","add3":"","madd1":"62 CRAIG DR","madd2":"APT 7D","madd3":"","mcity":"W SPRINGFIELD","mstate":"MA","mzip":"01089","pcpfaxno":"","pcpnpi":1457876542,"currentgendcomment":"","pphycomment":"","uniqueid":66235800,"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","E1142","E1121","E538","E785","Z125","E1140","L0291","E1165","L720","F331","E66813","K0889","E782","Z6841","Z713","F4310","F411","E6601","I10","Z794","G501","G4733"],"date":["2025-11-03","2024-07-29","2025-11-01","2024-07-20","2025-11-01","2024-07-20","2025-10-03","2025-03-03","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2024-12-03","2025-08-03","2024-07-29","2024-07-29","2024-07-29","2025-01-02","2025-03-21"],"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":[["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","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":""}]}]}