{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY K UNDERWOOD","gend":1,"currentgend":"","add":"4526 SE 26TH TER","city":"TOPEKA","state":"KS","zip":"666052030","dob":"1956-11-20","age":"","mstatus":"","insh":"K44003061","cliId":"","pno":"7852131354","cno":"7858067379","email":"chattiukathy@att.net","ename":"","eno":"","pphy":"CYNTHIA SCHEIBE","ppno":"7856549591","pcpadd":"2902 SW ASBURY DR","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1670","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1700821238","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003061","medicareid":"3HA5RC0QV74","medicaidid":"3HA5RC0QV74","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":["G4700","H2513","H40053","E119","E871","N1831","Z6841","F1020","I10","E782","M25562","G8929","M25561","M25511","R92333","Z803","H6122","R399","Z0000","I129","E1122","F325","R748","R634","R790","G5701","M25551","M5441","Z87898","E1165","R799","M170","E271","Z01818","G4739","K2100","K219","R9431","Z96651","G8918","G4709","M1712","Z7985","G4733","F32A","F419","Z7984","Z885","E66812","E785","Z6839","Z96652","Z96641","Z96642","H40033"],"date":["2026-04-14","2026-04-29","2024-04-03","2026-04-20","2025-12-31","2025-04-15","2024-04-15","2024-07-17","2026-04-20","2026-04-06","2025-08-19","2025-09-09","2026-01-15","2024-09-25","2026-03-17","2026-03-17","2024-11-20","2024-12-03","2025-12-31","2024-12-16","2024-12-16","2026-01-05","2024-12-16","2024-12-16","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2026-01-05","2025-10-31","2025-10-20","2025-10-31","2026-04-06","2026-04-06","2026-01-05","2026-04-20","2025-10-20","2025-12-31","2026-01-21","2025-12-31","2025-12-31","2026-04-20","2026-04-20","2026-01-21","2025-11-05","2026-04-20","2026-04-20","2026-01-05","2026-04-20","2026-01-05","2026-03-19","2026-02-05","2026-04-20","2026-04-29"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","GLIPIZIDE ER","2.5 MG","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","LATANOPROST","0.01%","","Select","Select",""],["","","PIOGLITAZONE HYDROCHLORIDE","15 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","TRANEXAMIC ACID","650 MG","","Select","Select",""],["","","CLOBETASOL PROPIONATE","0.05%","","Select","Select",""],["","","ESCITALOPRAM OXALATE","5 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","100 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","2 MG","","Select","Select",""],["","","OMEPRAZOLE DR","20 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","CELECOXIB","200 MG","","Select","Select",""],["","","CEFADROXIL","500 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","Cefadroxil Cap","500 MG","","Select","Select",""],["","","Tranex Acid Tab","650 MG","","Select","Select",""],["","","Smz\/Tmp Ds Tab 800-160","","","Select","Select",""],["","","Comirnaty Inj 30\/.3Ml","","","Select","Select",""],["","","Mounjaro Inj 12.5\/0.5","","","Select","Select",""],["","","Escitalopram Tab","5 MG","","Select","Select",""],["","","Pioglitazone Tab","15 MG","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Fluad Inj 2025-26","","","Select","Select",""],["","","Tizanidine Tab","4 MG","","Select","Select",""],["","","Metoprol Suc Tab","100 MG","","Select","Select",""],["","","Clobetasol Oin 0.05%","","","Select","Select",""],["","","Ondansetron Tab","4 MG","","Select","Select",""],["","","Glipizide Er Tab","2.5 MG","","Select","Select",""],["","","Latanoprost Sol 0.005%","","","Select","Select",""],["","","Celecoxib Cap","200 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Oxycodone Tab","5 MG","","Select","Select",""],["","","Losartan Pot Tab","100 MG","","Select","Select",""],["","","Trazodone Tab","50 MG","","Select","Select",""],["","","Amlodipine Tab","5 MG","","Select","Select",""],["","","Atorvastatin Tab","10 MG","","Select","Select",""],["","","Omeprazole Cap","20 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":""}]}]}