{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGIA A SAVILONIS","gend":1,"currentgend":"","add":"3400 SW AMAROSA CIR","city":"TOPEKA","state":"KS","zip":"66614","dob":"1941-02-22","age":"","mstatus":"","insh":"K44003288","cliId":"","pno":"8173603050","cno":"","email":"GSAVILONIS@GMAIL.COM","ename":"","eno":"","pphy":"HANNAH SMITH","ppno":"7852331747","pcpadd":"901 SW GARFIELD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1696","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1376177196","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003288","medicareid":"2XA1JN8DY90","medicaidid":"","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":["Z79899","Z79811","W57XXXA","R92323","Z0000","R21","H6121","R600","R7989","F4329","G8929","M25511","M7581","M85852","Z170","L821","L578","L814","Z5986","D649","R92333","N3281","C50211","R5383","R946","Z780","Z13820","C50911","Z5941","M8580","W1839XA","Y929"],"date":["2024-08-21","2026-02-11","2024-06-27","2024-10-17","2025-11-19","2024-11-06","2024-11-06","2025-11-19","2024-11-06","2025-11-19","2025-11-19","2025-11-19","2025-08-05","2026-02-11","2026-02-11","2025-08-26","2025-08-26","2025-08-26","2025-08-26","2026-02-11","2025-10-20","2025-11-19","2025-11-19","2025-11-19","2025-01-02","2025-01-20","2025-01-20","2025-01-20","2025-02-26","2026-02-11","2026-06-03","2026-06-03"],"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":[["","","ANASTROZOLE","1 MG","","Select","Select",""],["","","MUPIROCIN","2%","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","TROSPIUM CHLORIDE","20 MG","","Select","Select",""],["","","ESTRADIOL","0.01%","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE AUGMENTED","0.05%","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2024-25","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","5 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":""}]}]}