{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLY F BALL","gend":1,"currentgend":"","add":"14521 SPRING VALLEY CIRCLE","city":"WICHITA","state":"KS","zip":"67230","dob":"1962-01-28","age":"","mstatus":"","insh":"33025953050873","cliId":"","pno":3166444047,"cno":"","email":"KELLY@KELLYBALLHOMES.COM","ename":"","eno":"","pphy":"KAYLEE DANIEL","ppno":3167339355,"pcpadd":"231 S ANDOVER ROAD","pcpcity":"ANDOVER","pcpstate":"KS","pcpzip":"67002","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"ACA","lob":"SMALL GROUP METALLIC","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"14521 SPRING VALLEY CIRCLE","madd2":"","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"67230","pcpfaxno":"          ","pcpnpi":1184487142,"currentgendcomment":"","pphycomment":"","uniqueid":"XSB877535848","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C49A3","Z01818","C787","C7951","C782","C786","C772","C7801","J90","R197","G893","I10","F419","Z79899","Z7982","Z79624","Z9221","Z87891","Z881","R918","Z86711","C7800","C7989","E875","I2699","R591","K219","R911","C494"],"date":["2026-04-15","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-02-02","2026-02-02","2026-01-05","2026-01-05","2026-01-05","2026-03-30","2026-03-02","2026-04-15"],"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":[["","","LOKELMA","","","Select","Select",""],["","","SUNITINIB MALATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LEVOFLOXACIN","","","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":""}]}]}