{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARLENE K BONTRAGER","gend":1,"currentgend":"","add":"8705 S Sandcreek Rd","city":"Hutchinson","state":"KS","zip":"67501","age":"","mstatus":"","insh":"K44002732","cliId":"","pno":"6209606754","cno":"6206646209","email":"bontragera74@gmail.com","ename":"","eno":"","pphy":"MORGAN DEWEY","ppno":"6202592325","pcpadd":"1133 SW TOPEKA BLVD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"67460-2326","pcpcounty":"","pcpid":"","pcpname":"CAPSTONE ORTHOPEDICS & SPORTS MEDIC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1366000762","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44002732","medicareid":"8T16KU9NF64","medicaidid":"8T16KU9NF64","pcpFlag":"","dob":"1956-02-16"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["E876","R002","I447","L820","Z85828","E785","I10","I509","R0602","I700","J9811","Z950","M19032","M67442","M67432","M71332","I071","I351","L7211","L821","D2330","Z1231","N814","N951","N200","I493","R0600","Z7982","Z79899","I5023","I420","I428","I110","K5792","L570"],"date":["2025-03-13","2024-07-18","2025-08-12","2024-04-24","2024-04-24","2025-07-17","2025-05-08","2025-07-17","2025-07-17","2025-08-12","2025-08-12","2025-08-12","2025-03-27","2025-03-27","2025-01-16","2025-02-26","2025-04-04","2025-04-04","2026-04-27","2025-04-24","2026-04-27","2025-05-05","2025-05-05","2025-05-05","2025-04-13","2025-04-22","2025-04-13","2025-08-12","2025-08-12","2025-08-12","2025-08-12","2025-04-22","2025-04-13","2025-04-13","2026-04-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","LOSARTAN POTASSIUM","25 MG","","Select","Select",""],["","","CARVEDILOL","3.125 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","SPIRONOLACTONE","50 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","51 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","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":""}]}]}