{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY E BRIGGS","gend":1,"currentgend":"","add":"721 NE Poplar Street","city":"Topeka","state":"KS","zip":"66616","age":"","mstatus":"","insh":"K44001774","cliId":"","pno":"7852134707","cno":"","email":"briggs721@yahoo.com","ename":"","eno":"","pphy":"MARILYN MCKEE","ppno":"7852704600","pcpadd":"3707 SW 6TH AVE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-2084","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1083725352","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44001774","medicareid":"7CP7WM2EX58","medicaidid":"","pcpFlag":"","dob":"1963-05-11"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["M79641","R29898","Z9682","Z79891","S52501D","Z8781","Z79899","Z780","Z13820","R109","Z6844","R7303","I10","E782","M6208","E063","R1900","K469","R609","M25641","Z09","E038","E6601","K219","G4733","M5416","F419","G959","Z720","N3941","N950","E66813","M5417","M5137","M797","F17210","K589","M1990","G4730","Z9049","Z880","Z882","Z91041","F411","F509","R92323","F331","M150","G8929","E559","M818","H25813","F439","Z0000","R21","R760","M170","R7689","H3022","H3021","H35352","H21541","H43811","H2513"],"date":["2024-03-21","2024-03-07","2024-07-11","2024-07-11","2024-03-18","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2024-03-05","2026-05-20","2026-06-17","2026-06-17","2026-06-17","2024-03-05","2026-03-31","2024-02-27","2024-02-27","2024-02-27","2024-03-21","2024-03-05","2024-03-21","2026-05-20","2026-06-17","2026-06-17","2025-11-19","2025-06-04","2024-07-11","2024-07-01","2025-05-27","2024-07-01","2026-06-17","2024-01-25","2024-01-25","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2025-11-19","2026-06-17","2025-07-24","2026-06-17","2025-11-19","2025-11-19","2026-05-20","2026-05-20","2025-12-09","2025-02-26","2025-05-27","2025-05-27","2026-01-27","2026-01-27","2026-03-30","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","VALSARTAN","80 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","Select","Select",""],["","","TROSPIUM CHLORIDE","20 MG","","Select","Select",""],["","","AMITRIPTYLINE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","100 MCG","","Select","Select",""],["","","METOPROLOL TARTRATE","50 MG","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","0.50%","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","150 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","30 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","300 MG","","Select","Select",""],["","","TOPIRAMATE","50 MG","","Select","Select",""],["","","LEVOXYL","50 MCG","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","DULOXETINE HCL","30 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":""}]}]}