{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Grisel Cruz","gend":1,"currentgend":"","add":"11 CLARK ST","city":"HOLYOKE","state":"MA","zip":"01040","dob":"1972-09-09","age":"","mstatus":"","insh":"C0007418400","cliId":"","pno":4133138506,"cno":"","email":"","ename":"","eno":"","pphy":"Kenneth Aquilino","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":"# 2","add3":"","madd1":"11 CLARK ST","madd2":"# 2","madd3":"","mcity":"HOLYOKE","mstate":"MA","mzip":"01040","pcpfaxno":"","pcpnpi":1770583668,"currentgendcomment":"","pphycomment":"","uniqueid":66823050,"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","I10","I255","E7800","E538","E559","R300","Z1231","R102","N83201","I2510","R002","R739","D649","N840","M79672","M79671","E785","I25119","I479","R202","M5136","M2550","F419","E663","Z1211","Z955","Z79899","R000","M51360","M722","R1033","Z6826","R2242","R42","R7301","Z7982","Z113","N83291","Z01419","N841","G5790","M7741","M7742","M5416","M7732"],"date":["2025-11-11","2025-04-11","2025-08-09","2025-12-05","2025-12-05","2025-08-09","2025-11-09","2024-04-23","2024-05-24","2024-05-24","2025-02-12","2024-04-29","2025-11-09","2025-12-05","2024-09-09","2025-12-05","2025-12-05","2024-09-18","2025-08-09","2024-09-18","2025-08-09","2024-09-18","2025-08-09","2025-08-09","2025-05-21","2024-08-27","2024-08-27","2025-08-09","2025-08-09","2025-08-09","2025-03-02","2025-09-05","2025-05-21","2025-10-22","2025-04-11","2025-08-09","2025-08-09","2024-05-21","2024-05-24","2024-05-29","2024-09-09","2025-01-20","2025-01-20","2025-01-20","2025-06-03","2025-08-09"],"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":[["","","BRILINTA","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","PRALUENT PEN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","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":""}]}]}