{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER KINGSBURY","gend":1,"currentgend":"","add":"503 S MADISON ST","city":"SMITH CENTER","state":"KS","zip":"66967","dob":"1973-11-14","age":"","mstatus":"","insh":"12823512603011","cliId":"","pno":7852826593,"cno":"","email":"HAIRSTYLIST73@HOTMAIL.COM","ename":"","eno":"","pphy":"HALLIE THEOBALD","ppno":7852826834,"pcpadd":"921 E HIGHWAY 36","pcpcity":"SMITH CENTER","pcpstate":"KS","pcpzip":"66967","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"ACA","lob":"INDIVIDUAL METALLIC","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"503 S MADISON ST","madd2":"","madd3":"","mcity":"SMITH CENTER","mstate":"KS","mzip":"66967","pcpfaxno":"","pcpnpi":1992384002,"currentgendcomment":"","pphycomment":"","uniqueid":"XSN832252506","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9901","M542","M9902","M9905","R350","M2550","M25511","M064","M7582","M7581","M797","M25512","F32A","Z79899","Z6842","Z1231","N644","R232","N939","N952","N898","Z803","Z8041","Z85850","Z9089","M3500","N809","E230","D699","Z362","Z5181","E890"],"date":["2026-04-01","2026-04-01","2026-04-01","2026-04-01","2026-02-10","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-02-18","2026-02-18","2026-02-18","2026-01-15","2026-01-15","2026-01-15","2026-02-18"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","TOPIRAMATE ER SPRINKLE","","","Select","Select",""],["","","ARMOUR THYROID","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","DEXLANSOPRAZOLE DR","","","Select","Select",""],["","","COLESEVELAM HCL","","","Select","Select",""],["","","VEOZAH","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","NYSTATIN","","","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":""}]}]}