{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEIDI D MARK","gend":1,"currentgend":"","add":"315 NE ASPEN LN","city":"TOPEKA","state":"KS","zip":"66617","dob":"1981-01-21","age":"","mstatus":"","insh":"31006805101413","cliId":"","pno":7856336422,"cno":"","email":"HEIDI@ENDEAVORPW.COM","ename":"","eno":"","pphy":"KATIE JOHNSON","ppno":7853549591,"pcpadd":"901 SW GARFIELD AVE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"ACA","lob":"SMALL GROUP METALLIC","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"315 NE ASPEN LN","madd2":"","madd3":"","mcity":"TOPEKA","mstate":"KS","mzip":"66617","pcpfaxno":"","pcpnpi":1174230742,"currentgendcomment":"","pphycomment":"","uniqueid":"XSB858528447","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C55","Z936","R319","D72829","T83022A","I429","N1330","N9989","J45909","E039","N368","Z933","Z85841","Z8049","Z803","Z800","Z808","Z7901","D649","M728","M7989","R1902","Z8542","R140","R000","R112","G893","K5901","Z658","R630","N189","K439","C7989","E890","R110","Z733","R1110","R918","J9811","N2889","N289","C786","N1339","R188","K3189","J90","I2699","E43","N9961","K567","D684","N179","K219","Z79890","Z79899","Z7951","I513","N3945","Z95828","Z905","R590","Z86718","K6811","L02211","R390","R5383","T8143XA","I959","D630","C763","D6959","T451X5A","R143","Z5111","Z5112","Z934","I5022","I427","K3184","E860","J4540","J301","J329","J40","Z01419","Z08","Z90711","C499","Z01810","Z01818","D709","R1909","R591","Z9221","R1904","K689","I82220","I998","G8918","Z124"],"date":["2026-04-08","2026-03-13","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-04-15","2026-03-10","2026-01-30","2026-02-02","2026-01-21","2026-03-26","2026-02-25","2026-02-14","2026-02-12","2026-04-08","2026-02-16","2026-02-13","2026-02-13","2026-02-13","2026-02-14","2026-02-06","2026-01-22","2026-02-16","2026-02-16","2026-01-30","2026-02-14","2026-02-14","2026-02-27","2026-01-30","2026-01-30","2026-02-25","2026-03-13","2026-02-25","2026-02-25","2026-02-27","2026-02-24","2026-01-21","2026-01-21","2026-01-21","2026-02-12","2026-01-21","2026-01-21","2026-01-21","2026-01-21","2026-04-17","2026-02-18","2026-02-13","2026-02-14","2026-02-14","2026-02-14","2026-02-16","2026-02-16","2026-02-19","2026-02-06","2026-02-12","2026-02-12","2026-02-12","2026-02-12","2026-02-12","2026-02-12","2026-02-03","2026-03-24","2026-03-24","2026-02-04","2026-04-15","2026-04-15","2026-02-24","2026-02-24","2026-04-13","2026-04-13","2026-04-13","2026-04-13","2026-03-26","2026-03-26","2026-03-26","2026-03-06","2026-01-15","2026-01-16","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-01-16","2026-01-16","2026-01-16","2026-01-22","2026-01-21","2026-03-26"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","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":""}]}]}