{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY R DAVIS","gend":1,"currentgend":"","add":"12651 142ND ROAD","city":"MAYETTA","state":"KS","zip":"66509","dob":"1985-02-03","age":"","mstatus":"","insh":"14150589317818","cliId":"","pno":7855012861,"cno":"","email":"ADAVIS@WNNJCPA.COM","ename":"","eno":"","pphy":"KRYSTAL BRUNIN","ppno":7853549959,"pcpadd":"823 SW MULVANE ST","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"ACA","lob":"SMALL GROUP METALLIC","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"12651 142ND ROAD","madd2":"","madd3":"","mcity":"MAYETTA","mstate":"KS","mzip":"66509","pcpfaxno":7852315996,"pcpnpi":1649636549,"currentgendcomment":"","pphycomment":"","uniqueid":"XSB847230270","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E88810","E66812","F50811","I10","K219","G4733","N6489","M9901","G44209","M5413","M542","M9902","M546","M9903","M5459","M9905","M9904","I4510","Z136","Z1231","R92333"],"date":["2026-04-22","2026-04-22","2026-04-22","2026-04-22","2026-04-22","2026-04-22","2026-04-07","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2026-01-12","2026-01-12","2026-03-23","2026-03-23"],"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":[["","","FLUOXETINE HCL","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LISDEXAMFETAMINE DIMESYLATE","","","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":""}]}]}