{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLARA M FRIDAY","gend":1,"currentgend":"","add":"4121 SHILOH CT","city":"TECUMSEH","state":"KS","zip":"66542","age":"","mstatus":"","insh":"K44002882","cliId":"","pno":"7858179472","cno":"","email":"mfriday1981@gmail.com","ename":"","eno":"","pphy":"KELLI NEW","ppno":"7856549591","pcpadd":"901 SW GARFIELD AVE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1670","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4121 SHILOH CT","madd2":"","madd3":"","mcity":"TECUMSEH","mstate":"KS","mzip":"66542","pcpfaxno":"","pcpnpi":"1568479160","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44002882","medicareid":"4HG9GW7HT18","medicaidid":"4HG9GW7HT18","pcpFlag":"","dob":"1947-12-09"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K219","B0229","Z131","R739","Z6830","T380X5A","E669","E785","E039","M7138","Z981","I890","T66XXXS","T66XXXD","M25532","M48061","M51369","M47816","H903","H9201","E782","R030","F331","E038","M5416","M25542","M79645","J410","Z85810","H04123","H53031","H5203","M4306","L0291","M4807","M79644","M4726","R7303","G500","Z79899","Z888","Z7722","F32A","Z01812","B1910","C139","B351","M51360"],"date":["2026-01-06","2025-06-21","2025-06-21","2025-06-21","2025-06-21","2025-06-21","2025-06-21","2025-09-12","2025-09-12","2025-06-21","2026-04-21","2025-09-24","2025-09-24","2025-09-24","2025-10-14","2026-06-05","2025-01-16","2025-01-16","2025-01-27","2025-01-27","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2025-05-22","2025-02-04","2025-02-04","2026-01-06","2025-03-06","2026-04-15","2026-04-15","2025-03-14","2025-05-20","2025-06-10","2025-06-21","2025-06-10","2025-06-21","2025-06-21","2025-06-21","2025-06-21","2025-09-12","2025-06-21","2025-09-12","2025-05-20","2025-05-20","2026-01-06","2026-01-06","2026-06-05"],"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":[["","","LEVOTHYROXINE SODIUM","112 MCG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","MUPIROCIN","2%","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","5 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","VALACYCLOVIR HYDROCHLORIDE","500 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","TIZANIDINE HCL","2 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","TERBINAFINE HYDROCHLORIDE","250 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","Smz\/Tmp Ds Tab 800-160","","","Select","Select",""],["","","Levothyroxin Tab","88 MCG","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Terbinafine Tab","250 MG","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Mupirocin Oin 2%","","","Select","Select",""],["","","Tizanidine Tab","2 MG","","Select","Select",""],["","","Oxycodone Tab","5 MG","","Select","Select",""],["","","Famotidine Tab","40 MG","","Select","Select",""],["","","Rosuvastatin Tab","5 MG","","Select","Select",""],["","","Valacyclovir Tab","500 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":""}]}]}