{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA SUE J FELICIANO","gend":1,"currentgend":"","add":"7511 SW 53RD ST","city":"TOPEKA","state":"KS","zip":"66610","dob":"1989-03-15","age":"","mstatus":"","insh":"31360801419804","cliId":"","pno":7854099952,"cno":"","email":"","ename":"","eno":"","pphy":"DARYN SCHMIDT","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":"7511 SW 53RD ST","madd2":"","madd3":"","mcity":"TOPEKA","mstate":"KS","mzip":"66610","pcpfaxno":"          ","pcpnpi":1326148511,"currentgendcomment":"","pphycomment":"","uniqueid":"XSB867999538","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4730","R5383","J0140","Z01812","Z13228","Z130","Z1329","R739","Z131","Z13220","M3500","M329","M069","G4700","F419","F410","E039","G4733","G4710","L932","M328","H9201","M26601","E7800","N898","Z113","R300","E0590"],"date":["2026-01-06","2026-03-24","2026-03-03","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-03-24","2026-04-07","2026-01-20","2026-02-10","2026-02-10","2026-02-27","2026-01-15","2026-01-15","2026-01-20","2026-03-11"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","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":""}]}]}