{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY L GRAHAM","gend":1,"currentgend":"","add":"1440 SW Belle Ave","city":"Topeka","state":"KS","zip":"66604","dob":"1950-01-08","age":"","mstatus":"","insh":"1Q83ET2XD09","cliId":"","pno":"7852726358","cno":"7852218377","email":"maryg@swbell.net","ename":"","eno":"","pphy":"RAAZIA AFTAB","ppno":"7852324248","pcpadd":"2641 SW WANAMAKER RD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1663","pcpcounty":"","pcpid":"","pcpname":"TOPEKA PHYSICIAN GROUP LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1440 SW Belle Ave","madd2":"","madd3":"","mcity":"Topeka","mstate":"KS","mzip":"66604","pcpfaxno":"","pcpnpi":1629554696,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1Q83ET2XD09","medicaidid":"1Q83ET2XD09","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":[]},{"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":[["","","Verapamil Tab","240 MG","","Select","Select",""],["","","Prevnar 20 Inj","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Ezetimibe Tab","10 MG","","Select","Select",""],["","","Nystatin Pow 100000","","","Select","Select",""],["","","Cyclobenzapr Tab","5 MG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Bupropion Tab","75 MG","","Select","Select",""],["","","Shingrix Inj","50\/0.5 ML","","Select","Select",""],["","","Losartan Pot Tab","100 MG","","Select","Select",""],["","","Buspirone Tab","5 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Levothyroxin Tab","75 MCG","","Select","Select",""],["","","Duloxetine Cap","30 MG","","Select","Select",""],["","","Liothyronine Tab","5 MCG","","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":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"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":""}]}]}