{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH J PRICE","gend":1,"currentgend":"","add":"409A Circle Dr","city":"Mayetta","state":"KS","zip":"66509","dob":"1953-05-02","age":"","mstatus":"","insh":"9Q12WR9WY89","cliId":"","pno":"9137096251","cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"409A Circle Dr","madd2":"","madd3":"","mcity":"Mayetta","mstate":"KS","mzip":"66509","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9Q12WR9WY89","medicaidid":"9Q12WR9WY89","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":[["","","Colestipol Tab","1 GM","","Select","Select",""],["","","Smz\/Tmp Ds Tab 800-160","","","Select","Select",""],["","","Invokana Tab","300 MG","","Select","Select",""],["","","Truplus Lanc Mis","28 G","","Select","Select",""],["","","Januvia Tab","100 MG","","Select","Select",""],["","","Ibuprofen Tab","600 MG","","Select","Select",""],["","","Colchicine Tab","0.6 MG","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Fluconazole Tab","150 MG","","Select","Select",""],["","","Diltiazem Cap","120 MG","","Select","Select",""],["","","Azithromycin Tab","500 MG","","Select","Select",""],["","","Cyclobenzapr Tab","5 MG","","Select","Select",""],["","","Clindamycin Cap","150 MG","","Select","Select",""],["","","Estradiol Cre 0.01%","","","Select","Select",""],["","","Tizanidine Tab","4 MG","","Select","Select",""],["","","Clobetasol Oin 0.05%","","","Select","Select",""],["","","Celecoxib Cap","200 MG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Alogliptin Tab","25 MG","","Select","Select",""],["","","Ondansetron Tab","4 MG","","Select","Select",""],["","","Repaglinide Tab","2 MG","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Ipratropium Spr 0.03%","","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Telmisartan Tab","40 MG","","Select","Select",""],["","","Oxycodone Tab","5 MG","","Select","Select",""],["","","Telmisa\/Hctz Tab 40-12.5","","","Select","Select",""],["","","Lorazepam Tab","0.5 MG","","Select","Select",""],["","","Clotrim\/Beta Cre Diprop","","","Select","Select",""],["","","Atorvastatin Tab","20 MG","","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":""}]}]}