{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kirk Zaleski","gend":0,"currentgend":"","add":"96 PHEASANT RUN CIR","city":"LEOMINSTER","state":"MA","zip":"01453","dob":"1962-10-13","age":"","mstatus":"","insh":"C0034934300","cliId":"","pno":"9785498308","cno":"","email":"","ename":"","eno":"","pphy":"Tisha N Dickey","ppno":"9785824587","pcpadd":"324 Massachusetts Ave","pcpcity":"Lunenburg","pcpstate":"MA","pcpzip":"01462","pcpcounty":"","pcpid":"","pcpname":"Revere Medical of Massachusetts, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"96 PHEASANT RUN CIR","madd2":"","madd3":"","mcity":"LEOMINSTER","mstate":"MA","mzip":"01453","pcpfaxno":"","pcpnpi":"1588984264","currentgendcomment":"","pphycomment":"","uniqueid":"147849550","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","S61206A","M79645","S68116A","S68626A","S62636B","R52","S68116D","M7711","N401","R350","H903","E785","J309","I10","M25521","J45909","Z91038","M25562","F32A","Z0100","S67196A","S61306A","M7989","M79644","Z0000","Z1211","H9313","R39198","H9190","G4733","J4520","N400","D229","L820","L7211","L720","L738","L538","D485","D1801"],"date":["2026-02-06","2025-03-22","2025-03-25","2025-04-23","2025-03-31","2025-03-31","2025-04-08","2025-08-06","2025-08-06","2025-07-07","2025-07-07","2025-06-16","2025-05-13","2025-03-06","2025-06-30","2025-05-13","2025-05-13","2025-05-13","2025-05-13","2025-05-13","2025-03-19","2025-03-22","2025-03-22","2025-03-25","2025-04-08","2025-05-13","2025-05-13","2025-05-13","2025-06-30","2025-05-13","2025-12-16","2025-05-14","2025-07-07","2025-09-16","2025-09-16","2025-11-13","2025-09-16","2025-09-16","2025-09-16","2025-11-13","2025-09-16"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","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":""}]}]}