{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Adam D Shramek","gend":0,"currentgend":"","add":"56 EVERGREEN DR","city":"MARSTONS MLS","state":"MA","zip":"02648","dob":"1978-10-29","age":"","mstatus":"","insh":"C0028490801","cliId":"","pno":5087764836,"cno":"","email":"","ename":"","eno":"","pphy":"Stephanie Delande","ppno":5087719599,"pcpadd":"94 Main St,","pcpcity":"Hyannis","pcpstate":"MA","pcpzip":"02601","pcpcounty":"","pcpid":"","pcpname":"Duffy Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"5087764836","add2":"","add3":"","madd1":"56 EVERGREEN DR","madd2":"","madd3":"","mcity":"MARSTONS MLS","mstate":"MA","mzip":"02648","pcpfaxno":"","pcpnpi":1245651322,"currentgendcomment":"","pphycomment":"","uniqueid":136885051,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E781","R7301","R5383","Z0000","M2550","F341","M25541","M25542","M25511","M25512","M25521","M25571","M25572","M25522","G894","H35713","G8929","M79671","M79672","M79642","M79641","M19012","M19011","M19041","M19042","M19021","M19022","M25721","M170","M19071","M19072","Z1211"],"date":["2025-09-29","2025-09-29","2025-09-29","2025-08-10","2025-08-10","2025-09-10","2025-11-26","2025-11-26","2025-11-25","2025-11-25","2025-11-25","2025-04-11","2025-04-11","2025-11-25","2025-04-11","2025-03-11","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2025-11-24"],"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":[["","","TRAMADOL HCL-ACETAMINOPHEN","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUARIX 2025-2026","","","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":""}]}]}