{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENNIS K CARYL","gend":0,"currentgend":"","add":"1933 SW Lane St","city":"Topeka","state":"KS","zip":"66604","dob":"1942-09-01","age":"","mstatus":"","insh":"K44002280","cliId":"","pno":"7858366166","cno":"","email":"Bettycaryl49@gmail.com","ename":"","eno":"","pphy":"BAILEY SCHMIDT","ppno":"7852721845","pcpadd":"2902 SW ASBURY DR","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66614-4466","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1933 SW Lane St","madd2":"","madd3":"","mcity":"Topeka","mstate":"KS","mzip":"66604","pcpfaxno":"","pcpnpi":"1649917832","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44002280","medicareid":"4EC6GC1UE63","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","I77810","I351","I340","Z98890","I2510","Z8501","K222","Z9049","R1310","I4891","N189","C155","G629","Z862","N1832","H35363","H31011","H04123","Z961","Z125","Z13220","I4821","E161","L570","C4441","L89893","Z85828","Z7901","L98492","Z8673","Z96649","Z8249","D485","L821","Z0000","E785","I129","H5702","C44311","L728","R601","I4819","M179","H57052","H53453","H31003","I87321","C44319","Z7189","D500","D696","R944","R748","R7401","R7309","E782","G620","T451X5A","I080","Z980","Z79899","K130","L905","R7303","I480"],"date":["2026-03-24","2025-07-11","2026-03-24","2026-03-24","2026-03-24","2024-01-02","2025-07-11","2025-07-11","2025-07-11","2024-04-01","2024-04-01","2024-04-01","2025-07-07","2024-05-29","2024-05-29","2025-07-11","2025-07-09","2025-07-09","2025-07-09","2024-07-29","2024-07-01","2024-07-01","2025-07-07","2026-02-17","2025-07-03","2024-12-02","2024-08-07","2025-12-08","2026-03-24","2024-12-02","2024-08-26","2024-08-26","2024-10-28","2025-12-08","2025-07-03","2025-07-07","2025-07-07","2025-07-11","2025-07-07","2025-07-03","2025-07-03","2025-07-21","2025-07-11","2025-07-11","2025-07-09","2025-07-09","2025-07-09","2025-07-30","2025-09-16","2025-12-08","2025-12-17","2025-12-17","2025-12-21","2025-12-21","2025-12-21","2025-12-21","2026-03-24","2025-06-04","2025-06-04","2025-06-30","2025-07-11","2025-07-11","2025-09-16","2026-01-07","2026-02-17","2026-03-24"],"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":[["","","MICROLET LANCETS","","","Select","Select",""],["","","METOPROLOL TARTRATE","50 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","TRUE METRIX BLOOD GLUCOSEMETER","","","Select","Select",""],["","","DIGOXIN","0.125 MG","","Select","Select",""],["","","ELIQUIS","2.5 MG","","Select","Select",""],["","","GLUCAGON EMERGENCY KIT FOR LOW BLOOD SUGAR","1 MG","","Select","Select",""],["","","TRUE METRIX BLOOD GLUCOSE TEST STRIP","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","SHINGRIX","50\/0.5 ML","","Select","Select",""],["","","FLUOROURACIL","5%","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","CEFDINIR","300 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":""}]}]}