{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLEN E NIEHOFF","gend":0,"currentgend":"","add":"5726 SE CALIFORNIA AVE","city":"Topeka","state":"KS","zip":"66609","dob":"1953-08-24","age":"","mstatus":"","insh":"K44001863","cliId":"","pno":"7852133247","cno":"","email":"","ename":"","eno":"","pphy":"MELISSA AESCHLIMAN","ppno":"7852331747","pcpadd":"901 SW GARFIELD AVE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1696","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"007","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1487298352","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44001863","medicareid":"8MU8PN2QU49","medicaidid":"","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":{"diag":["I10","E7800","D229","L578","L821","Z85828","L219","L739","H2513","F411","F1011","R413","M4802","G6289","G2581","G5603","I2510","E559","K219","F418","M5441","Z79899","Z79620","Z87311","Z13820","M810","Z789","H17822","Z86010","K648","K5730","J0100","J3089","H25091","M069","G8929","R42","R791","Z87891","R040","J342","H17821","I499","D2239","D224","D2261","D2262","D2271","D2272","D225","R222","J310","R0982","J320","S058X9A","E785","L570","H2511","N400","G629","F419","F32A","Z885","Z888","Z122","H25011","H5704","L719","N529","Z961","N2889","N401","N138","R911","R338","R931","Z7982","Z8249","Z87898","L919","L710","C4441","Z125","M7910","M720","R0781","R3911","T466X5A","C44519","R9720","M542","R2681","M519","N281","J432","H8112","Z0000","D508","R252","N3281","R350","R339"],"date":["2026-06-16","2026-04-14","2025-06-11","2024-01-30","2025-06-11","2025-06-11","2025-06-11","2025-03-12","2024-03-08","2025-02-06","2025-08-06","2024-02-29","2025-08-06","2025-08-06","2026-04-14","2025-08-06","2025-04-09","2025-08-06","2025-08-06","2025-08-06","2025-08-06","2024-12-23","2024-03-05","2024-03-05","2024-03-05","2025-08-06","2025-10-17","2024-05-29","2024-05-22","2024-05-22","2024-05-22","2024-07-16","2024-07-16","2024-07-24","2024-12-23","2024-08-12","2026-03-10","2024-08-18","2025-10-17","2024-10-02","2024-10-02","2024-08-23","2024-08-28","2024-09-12","2024-09-12","2024-09-12","2024-09-12","2024-09-12","2024-09-12","2024-09-12","2024-09-12","2024-10-08","2026-06-03","2024-12-03","2024-12-23","2025-10-17","2024-12-23","2024-12-23","2024-05-22","2024-05-22","2024-05-22","2024-05-22","2024-05-22","2024-05-22","2025-05-27","2024-12-23","2024-12-23","2025-06-11","2026-05-15","2026-04-01","2025-12-15","2025-10-27","2026-01-28","2025-10-15","2026-06-16","2025-10-17","2025-10-17","2025-10-17","2026-05-15","2025-03-12","2025-03-12","2025-03-12","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-28","2025-05-15","2025-08-17","2025-08-17","2025-08-17","2026-05-15","2026-03-10","2026-04-02","2026-04-14","2026-04-14","2026-04-14","2026-06-02","2026-06-02","2026-06-02"],"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":[["","","ENALAPRIL MALEATE","5 MG","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","OMEPRAZOLE DR","20 MG","","Select","Select",""],["","","ROPINIROLE HYDROCHLORIDE","0.25 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","ALENDRONATE SODIUM","70 MG","","Select","Select",""],["","","AZELASTINE HYDROCHLORIDE","0.10%","","Select","Select",""],["","","PENICILLIN V POTASSIUM","500 MG","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","IPRATROPIUM BROMIDE","0.06%","","Select","Select",""],["","","REPATHA SURECLICK","140 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","GEMTESA","75 MG","","Select","Select",""],["","","PROCTO-MED HC","2.50%","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","METRONIDAZOLE","0.75%","","Select","Select",""],["","","KETOCONAZOLE","2%","","Select","Select",""],["","","MONTELUKAST SODIUM","10 MG","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","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":""}]}]}