{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maribel Santiago","gend":1,"currentgend":"","add":"25 KENDALL ST","city":"CHICOPEE","state":"MA","zip":"01020","dob":"1965-03-09","age":"","mstatus":"","insh":"C0021335100","cliId":"","pno":4132108876,"cno":"","email":"","ename":"","eno":"","pphy":"Melonie C Kalnenieks","ppno":4137348254,"pcpadd":"175 Carew St,Ste 200","pcpcity":"Springfield","pcpstate":"MA","pcpzip":"01104","pcpcounty":"","pcpid":"","pcpname":"Riverbend Medical Group,Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 KENDALL ST","madd2":"","madd3":"","mcity":"CHICOPEE","mstate":"MA","mzip":"01020","pcpfaxno":"","pcpnpi":1366601239,"currentgendcomment":"","pphycomment":"","uniqueid":100818400,"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","E119","E7800","K219","Z720","R399","B351","M25512","G44229","R42","E1129","R809","S51811A","Z23","I69351","I69328","E1165","E1159","I10","E785","K5900","F17210","F4323","R2689","Z794","I69322","I69398","R531","Z95811","I119","F17220","Z7982","Z7985","Z556","G8191","I6330","Z122","I639","I422","G510","R4701","R29703","Z7902","Z79899","R4781","R41841","I6381","B354","M25511","M4722","U071","J069","M25521","S21011A","S90512A","W540XXA","M7711","Z09","Z0000","I159","Z95818","D151","I749","R270","I498","R2681","I6930","M19071","E1140","M79674","M19072","M79675","N342","E1149","L600","L03115","S91101A","L97512","F331"],"date":["2026-01-23","2026-02-03","2025-12-16","2025-08-05","2025-08-01","2025-08-08","2025-10-17","2024-05-13","2024-11-21","2024-11-21","2025-08-05","2024-11-21","2025-03-06","2025-02-18","2025-06-01","2025-05-30","2025-08-05","2025-05-30","2025-12-16","2025-08-26","2025-05-30","2025-11-06","2025-05-30","2025-08-05","2026-01-27","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2026-01-27","2025-08-05","2025-08-05","2026-01-27","2025-07-31","2025-11-06","2026-01-27","2025-08-14","2025-05-26","2025-05-26","2025-05-26","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2024-06-07","2024-08-15","2024-07-12","2024-08-05","2024-08-05","2025-02-18","2025-02-18","2025-02-18","2025-02-18","2025-03-10","2025-06-13","2025-03-28","2025-05-23","2026-01-12","2025-06-04","2025-06-04","2025-05-26","2025-06-07","2025-06-01","2025-12-16","2025-10-16","2025-12-09","2025-10-16","2025-10-16","2025-10-16","2025-08-08","2025-10-16","2025-11-06","2025-12-09","2025-11-20","2025-12-09","2026-01-23"],"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":[["","","TRULICITY","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","NICOTINE PATCH","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DULOXETINE HCL","","","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":{"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":[]}]},{"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":""}]}]}