{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIEL J LEVALLEY","gend":0,"currentgend":"","add":"209 N LAKESIDE DR","city":"ANDOVER","state":"KS","zip":"67002","dob":"1950-01-19","age":"","mstatus":"","insh":"K44002670","cliId":"","pno":"3166501261","cno":"","email":"itssosowindy@sbcglobal.net","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"007","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1215788674","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44002670","medicareid":"1TW8GY7CA46","medicaidid":"1TW8GY7CA46","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":["E782","M170","M25562","M609","M66821","M75121","Z87891","G8918","Z96611","M19011","M66811","R7302","K219","M5030","N401","T148XXA","Y998","L578","L814","L821","L820","L298","L538","L570","T84498A","Z01818","I10","R509","R3911","M19019","T84098A","T8484XA","N400","Z79899","Z888","R1310","R0600","M7918","M48061","M47817","M5489","M47816","K2270","K449","Z471","D649","K5730","Z789","K2090","R252","M5450","J329","M51370","M4807","D2262","D2261","H353131","H04123","H524","M25511","M25611","M6281"],"date":["2025-02-26","2025-02-26","2025-02-26","2024-01-08","2024-01-24","2024-04-30","2024-08-15","2024-01-24","2026-03-24","2024-02-02","2024-04-30","2025-02-24","2024-08-16","2024-01-04","2025-02-26","2024-03-04","2024-03-04","2024-05-21","2026-01-13","2024-05-21","2024-05-21","2024-05-21","2024-05-21","2026-01-13","2024-06-21","2024-07-19","2025-02-24","2024-07-26","2024-07-26","2024-08-16","2024-08-15","2024-08-15","2024-08-15","2024-08-15","2024-08-15","2025-09-24","2025-06-25","2025-07-23","2026-06-10","2025-08-18","2026-03-12","2026-03-12","2025-09-24","2025-09-24","2025-02-07","2025-02-24","2025-02-24","2025-02-26","2025-02-26","2025-02-26","2025-02-26","2025-03-19","2025-08-18","2025-08-18","2026-01-13","2026-01-13","2026-02-27","2026-02-27","2026-02-27","2026-03-24","2026-04-16","2026-04-16"],"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":[["","","MELOXICAM","15 MG","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","ALFUZOSIN HCL ER","10 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","SILDENAFIL CITRATE","100 MG","","Select","Select",""],["","","PREDNISONE","50 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 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":""}]}]}