{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANA M KOCH","gend":1,"currentgend":"","add":"5504 SW OJAI ST","city":"TOPEKA","state":"KS","zip":"66614","dob":"1948-10-30","age":"","mstatus":"","insh":"K44002070","cliId":"","pno":"7852248936","cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5504 OJAI ST","madd2":"","madd3":"","mcity":"TOPEKA","mstate":"KS","mzip":"66614","pcpfaxno":"","pcpnpi":"1740453539","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44002070","medicareid":"8YF9F04QC54","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":["E7800","J40","M79671","M810","S92351A","I10","K219","E559","S99191D","S99191G","Z79620","Z79818","Z79899","Z780","Z13820","D23111","H04123","H5213","D72820","R238","L821","L408","E859","L720","Z5982","R110","Z01818","L409","Z888","R92323","M79652","N952","M25552","R531","F5101","Z1329","M5431","F40240","H43393","F419"],"date":["2025-12-19","2024-02-05","2024-05-06","2025-12-19","2024-03-12","2026-06-09","2025-12-19","2025-12-19","2024-03-11","2024-05-06","2024-04-11","2024-04-11","2024-04-11","2024-04-11","2024-04-11","2024-05-16","2026-05-28","2026-05-28","2024-12-09","2024-09-18","2024-09-18","2025-07-25","2024-09-18","2024-09-18","2024-09-18","2024-03-12","2024-03-12","2024-03-14","2024-03-14","2025-06-25","2025-07-25","2025-12-19","2025-10-17","2025-10-17","2025-12-19","2025-12-17","2025-02-24","2025-02-24","2026-05-28","2026-06-09"],"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":[["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","ESTRADIOL","0.01%","","Select","Select",""],["","","VENLAFAXINE HYDROCHLORIDE ER","75 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","SIMVASTATIN","80 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","ABRYSVO","120 MCG","","Select","Select",""],["","","OMEPRAZOLE DR","20 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","KETOCONAZOLE","2%","","Select","Select",""],["","","DIAZEPAM","5 MG","","Select","Select",""],["","","CLOBETASOL PROPIONATE","0.05%","","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":""}]}]}