{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GARY C SANDBERG","gend":0,"currentgend":"","add":"5216 ANNAPOLIS AVE","city":"Clearwater","state":"KS","zip":"67026","dob":"1953-05-22","age":"","mstatus":"","insh":"K44002337","cliId":"","pno":"3166198699","cno":"","email":"craigdi77@yahoo.com","ename":"","eno":"","pphy":"ADAM GOODWIN","ppno":3162740142,"pcpadd":"14700 W SAINT TERESA ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67235-9630","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":1376854059,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6TP3XV0JP71","medicaidid":"6TP3XV0JP71","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":[["","","ROSUVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","AZATHIOPRINE","50 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","25 MG","","Select","Select",""],["","","DAPAGLIFLOZIN PROPANEDIOL","10 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","ATENOLOL","50 MG","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","200 MG","","Select","Select",""],["","","LOVASTATIN","40 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","SHINGRIX","50\/0.5 ML","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","CARVEDILOL","3.125 MG","","Select","Select",""],["","","AMIODARONE HYDROCHLORIDE","200 MG","","Select","Select",""],["","","Dapagliflozi Tab","10 MG","","Select","Select",""],["","","Atenolol Tab","50 MG","","Select","Select",""],["","","Rosuvastatin Tab","40 MG","","Select","Select",""],["","","Metoprol Tar Tab","25 MG","","Select","Select",""],["","","Hydroxychlor Tab","200 MG","","Select","Select",""],["","","Furosemide Tab","40 MG","","Select","Select",""],["","","Pot Cl Micro Tab","20 MEQ","","Select","Select",""],["","","Oxycodone Tab","5 MG","","Select","Select",""],["","","Metoprol Suc Tab","25 MG","","Select","Select",""],["","","Shingrix Inj","50\/0.5 ML","","Select","Select",""],["","","Carvedilol Tab","3.125 MG","","Select","Select",""],["","","Azathioprine Tab","50 MG","","Select","Select",""],["","","Eliquis Tab","5 MG","","Select","Select",""],["","","Lovastatin Tab","40 MG","","Select","Select",""],["","","Amiodarone Tab","200 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":""}]}]}