{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Adam R Delisle","gend":0,"currentgend":"","add":"2 Lucia Road","city":"Marblehead","state":"MA","zip":"01945","dob":"1981-02-12","age":"","mstatus":"","insh":"C0006689101","cliId":"","pno":7815213489,"cno":"","email":"","ename":"","eno":"","pphy":"Lisa B Caruso","ppno":6174144639,"pcpadd":"725 Albany Street,Shapiro Building, Suite 7A","pcpcity":"Boston","pcpstate":"MA","pcpzip":"02118","pcpcounty":"","pcpid":"","pcpname":"Evans Medical Foundation, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 LUCIA RD","madd2":"","madd3":"","mcity":"MARBLEHEAD","mstate":"MA","mzip":"01945","pcpfaxno":"","pcpnpi":1316922099,"currentgendcomment":"","pphycomment":"","uniqueid":66324551,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R7989","R99","F419","L089","S0502XA","R1114","R110","K828","R1902","R601","E876","R61","R232","R609","Z0000","N1330","K439","N281","K760","F1090","R1011","R7401","F1020","Z125","E291","R1012","R1111","R112","Z79899","L03116","I8393","K2920","K7010","E8342","I10","E039","F1010","F32A","F411","F1021","M75111","M67813","M25511","Z13820","M8589","M85832","M818","R7309","E781","Z5181","M9902","M546","M9903","M5459","M9901","M9904","M79605","R079","R109","R197","R1013","I517","M75101","M75121","G8918","H5213","H52223","T7840XA","Z98890","S46291D","S46011D","Z6826","E663"],"date":["2025-10-26","2024-11-04","2025-12-31","2025-04-28","2025-11-22","2024-07-02","2024-07-02","2024-02-14","2024-02-14","2024-02-22","2024-06-24","2024-02-24","2024-05-02","2024-05-02","2024-07-26","2024-03-27","2024-03-27","2024-03-20","2024-07-05","2025-10-12","2024-03-20","2024-03-20","2024-12-16","2025-11-17","2025-11-17","2024-07-05","2024-07-05","2024-07-05","2024-07-05","2024-06-06","2024-06-06","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2025-10-12","2024-06-24","2024-08-21","2024-08-21","2024-08-21","2025-11-03","2024-10-16","2024-10-16","2024-10-16","2025-11-17","2024-12-16","2024-12-16","2025-10-29","2025-09-04","2025-09-04","2025-09-04","2025-09-04","2025-09-04","2025-09-04","2024-06-06","2024-07-06","2024-06-23","2024-06-23","2024-06-23","2024-06-24","2024-07-31","2025-09-05","2024-05-11","2024-11-20","2024-11-20","2024-08-11","2024-08-11","2025-11-03","2025-11-03","2025-04-28","2025-11-17"],"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":[["","","FUROSEMIDE","","","Select","Select",""],["","","KLOR-CON M10","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","ACAMPROSATE CALCIUM","","","Select","Select",""],["","","TESTOSTERONE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","VIVITROL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","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":""}]}]}