{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA L ZEMBAL","gend":1,"currentgend":"","add":"4441 SE GRAND OAKS AVE","city":"TOPEKA","state":"KS","zip":"666091647","dob":"1954-06-10","age":"","mstatus":"","insh":"K44003342","cliId":"","pno":"7852131689","cno":"","email":"","ename":"","eno":"","pphy":"KATY BLACK","ppno":"7858367111","pcpadd":"211 E MAIN ST","pcpcity":"CARBONDALE","pcpstate":"KS","pcpzip":"66414-9607","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":"1043608920","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003342","medicareid":"3WF1MN6TA03","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50512","Z170","E782","I10","E039","Z1211","Z79811","M62461","M7731","M79671","Z86010","K5730","K648","M85852","E6609","M7661","Z6834","D649","R109","E66811","S31105A","Z98890","K660","E88810","G8918","Z933","E785","Z853","Z8719","Z872","Z79890","Z79899","Z780","Z13820","M1711","H6123","R1032","R110","R82998","K5732","R188","K56609","K449","K658","K5792","R051","R92323","Z01818","L98492","K5720","E876","Z91041","Z860101","Z91018","Z6835","I959","R531","Z433","L7682","Z9049","Z6833","E8342","G4700","Z131","Z6831","I83892"],"date":["2026-05-20","2026-05-20","2026-06-04","2026-06-04","2026-02-09","2024-02-05","2026-05-20","2024-09-24","2024-09-24","2024-09-24","2024-05-09","2025-07-21","2024-05-09","2025-11-20","2026-02-09","2024-08-12","2025-11-12","2024-08-12","2024-08-17","2026-06-04","2025-06-23","2026-02-09","2025-06-13","2025-07-21","2025-07-07","2025-06-26","2025-06-13","2025-06-13","2025-06-13","2025-07-21","2025-08-18","2026-05-20","2025-08-18","2025-08-18","2025-08-20","2025-10-15","2025-01-07","2025-01-07","2025-01-07","2025-01-13","2025-01-13","2025-01-13","2025-06-16","2025-01-13","2025-01-22","2025-02-07","2026-04-13","2025-06-05","2025-07-21","2025-01-13","2025-06-13","2025-06-13","2025-06-13","2025-06-13","2025-01-13","2025-01-13","2025-01-13","2025-06-13","2025-05-19","2025-03-31","2025-06-13","2025-06-13","2025-06-13","2026-02-09","2026-02-09","2026-06-16"],"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":[["","","CAPVAXIVE","0.5 ML","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ANASTROZOLE","1 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","TOPIRAMATE","25 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","50 MCG","","Select","Select",""],["","","NEOMYCIN SULFATE","500 MG","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","0.12%","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE","","","Select","Select",""],["","","BOOSTRIX","","","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":""}]}]}