{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nyvia R Vazquez Pagan","gend":1,"currentgend":"","add":"425 S ELM ST","city":"HOLYOKE","state":"MA","zip":"01040","dob":"1977-08-08","age":"","mstatus":"","insh":"C0019384000","cliId":"","pno":4132750328,"cno":"","email":"","ename":"","eno":"","pphy":"Lorenver Po","ppno":4135368924,"pcpadd":"2 Hospital Dr,","pcpcity":"Holyoke","pcpstate":"MA","pcpzip":"01040","pcpcounty":"","pcpid":"","pcpname":"Western Mass Physician Associates","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 3R","add3":"","madd1":"425 S ELM ST","madd2":"APT 3R","madd3":"","mcity":"HOLYOKE","mstate":"MA","mzip":"01040","pcpfaxno":"","pcpnpi":1164422432,"currentgendcomment":"","pphycomment":"","uniqueid":97061350,"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","Z1211","K219","K5901","K589","E1165","D649","Z794","E038","E063","E1065","E6601","I10","L509","E7800","T7840XD","Z9641","Z4681","J40","R059","Z79899","J069","H6093","H9203","J029","Z03818","H6690","J209","J329","H6121","H6693","R0602","E119","E039","R922","E1021","E139","R809","F411","E109","R808","E1365","E669","Z6843","J309","M5416","M5450","E1040","E785","J45909","M5430","G8929","R0789","R110","R1013","R0683","M6289","M79672","M62838","M79662","M25572","M7752","M5440","E1340","E1321","M329","H409","Z01818","F419","F410","R079","Z1231","E11649","R42","B353","F331","F0631","J301","J3081","H2513","H524","E1121","K5900","T781XXA","J4520","E739","L299","L209","J302","J3089","T781XXD","T7840XA","H6691","N6310","E66813","H1013","M51360","R9431","G629","F418","E10649"],"date":["2026-02-15","2025-11-14","2025-11-14","2025-10-31","2024-04-16","2024-06-21","2024-05-29","2025-12-24","2025-11-18","2025-11-18","2026-01-23","2025-11-14","2025-12-08","2024-10-14","2025-12-08","2024-11-01","2025-06-19","2024-11-26","2024-10-22","2024-11-01","2025-11-18","2024-10-20","2024-10-20","2024-10-20","2024-10-20","2025-11-25","2024-11-01","2024-10-28","2025-02-04","2024-10-28","2024-10-28","2025-08-25","2025-11-25","2025-11-25","2024-12-16","2024-11-26","2025-11-18","2025-11-05","2025-12-13","2025-08-25","2025-02-19","2025-08-12","2025-10-27","2025-11-14","2025-05-08","2025-08-03","2025-10-15","2025-08-03","2025-08-03","2025-12-08","2025-08-12","2025-12-08","2025-08-25","2025-08-25","2025-10-31","2025-10-27","2025-12-24","2025-10-15","2025-11-14","2026-01-22","2025-11-05","2026-01-22","2025-12-08","2025-10-15","2025-10-15","2025-10-15","2025-10-15","2025-10-31","2025-11-25","2025-11-25","2025-11-25","2025-12-22","2025-12-08","2025-12-08","2025-12-24","2025-12-13","2025-12-13","2024-10-03","2024-10-03","2025-05-02","2025-05-02","2025-10-15","2024-05-30","2024-08-05","2024-08-05","2024-08-05","2024-08-05","2024-08-05","2024-08-05","2024-08-05","2024-08-05","2024-10-14","2024-10-28","2024-12-16","2025-02-21","2025-05-02","2025-08-03","2025-11-25","2025-10-15","2025-11-25","2025-12-08"],"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",""],["","","LEVOXYL","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","POLYETHYLENE GLYCOL 3350","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","GUAIFENESIN-CODEINE","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FIASP","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","BAQSIMI","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","NOVOLOG","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}