{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA W SEIM","gend":1,"currentgend":"","add":"5862 SW WOODRIDGE DR","city":"TOPEKA","state":"KS","zip":"66606","dob":"1940-05-30","age":"","mstatus":"","insh":"K44003359","cliId":"","pno":"7852677924","cno":"7859695142","email":"","ename":"","eno":"","pphy":"JED MCKEE","ppno":"7855846705","pcpadd":"901 SW GARFIELD AVE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66533-6705","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"007","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1699714949","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003359","medicareid":"7G98PY9CA10","medicaidid":"7G98PY9CA10","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":["L821","Z85828","G8929","I129","I739","N1832","M5450","R531","R7989","R5383","R519","E039","D72829","R944","R7309","E8342","R82998","Z87891","R079","I2510","K219","I10","I249","E782","E890","Z96653","R627","M48061","I6522","M5416","M4316","M7061","M7631","Z7902","M47816","E785","I6523","M546","M9903","M5451","L570","G5701","M7918","M25551","M48062","H43393","H5203","H52223","H524","Z961","M4306","M8588","M7989","I252","R5381","Z20822","I083","Z955","Z951","Z79899","Z723","Z634","L814","R600","K5641","M869","Z981","Z452","R918","T8131XA","M96842","E43","E876","E8351","E8339","D649","R630","N179","J9601","D631","Z742","M6284","G4709","F413","Z515","Z7189","Z8739","F419","Z6825","M549","R791","R7401","R748","R7982","R946","R636","E871","F32A","R45851","R9431","Z66","R8290","Z01818","R609","M79642","K529","Z043","R109","S3991XA","M79604","S0990XA","S3992XA","S24109A","S199XXA","S299XXA","S0993XA","W1839XA","Y929","M1611","R011","E222","M810","Z8619","Z885","Z888","Z7952","T8141XA","J189","D62","F3289","Z681","L02212","E860","M461","F329","Z9181","M533","G9341","N390","I5032","F03A0","R634","Z7409","Z8719","I5042","I130","F0390","R262","M6281","Z741","R1310","R4189"],"date":["2025-07-15","2025-07-15","2025-11-10","2025-12-10","2026-06-16","2026-02-13","2025-11-10","2025-09-03","2026-01-27","2024-03-25","2025-02-03","2026-02-09","2025-11-01","2026-01-27","2026-01-27","2025-11-01","2026-01-27","2026-02-03","2024-03-25","2026-02-13","2026-02-13","2026-06-16","2024-03-25","2026-02-03","2026-02-19","2026-02-03","2026-02-13","2025-11-01","2025-09-04","2025-12-10","2025-12-10","2024-07-09","2024-05-28","2026-02-03","2025-09-08","2026-06-16","2026-06-16","2026-03-20","2026-03-20","2026-03-20","2024-07-16","2024-07-12","2024-07-12","2025-09-16","2024-09-12","2024-11-18","2024-11-18","2024-11-18","2024-11-18","2024-11-18","2024-11-11","2024-11-11","2025-09-05","2026-02-03","2024-03-25","2026-02-03","2024-03-25","2026-02-03","2024-03-25","2026-02-03","2024-03-25","2024-03-25","2025-07-15","2025-09-16","2025-09-05","2025-09-05","2025-12-05","2025-09-05","2025-09-14","2025-09-23","2025-09-23","2025-12-05","2025-11-10","2025-11-10","2025-11-10","2025-11-10","2025-11-10","2026-02-09","2025-09-23","2025-12-05","2025-09-10","2025-12-05","2026-02-19","2025-09-24","2025-09-23","2025-09-17","2025-10-15","2025-12-05","2025-09-10","2025-09-03","2026-01-27","2026-01-27","2025-09-03","2026-01-27","2026-01-27","2026-02-13","2025-09-23","2025-09-10","2025-09-12","2025-09-07","2025-09-23","2025-09-09","2025-08-07","2025-11-21","2025-11-10","2025-11-21","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-05-30","2025-06-06","2025-08-23","2025-08-23","2026-02-03","2025-08-23","2025-08-23","2025-08-23","2025-09-23","2025-09-23","2025-09-23","2025-09-23","2026-02-03","2025-09-23","2026-02-03","2025-09-03","2025-12-05","2025-12-05","2025-03-26","2026-02-09","2026-01-27","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-10","2026-02-09","2026-02-03","2026-02-03","2026-02-09","2026-02-09","2026-02-09","2026-02-09","2026-02-09"],"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":[["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","80 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","100 MCG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","5 MG","","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATENOLOL","50 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","2 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","5 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","BUDESONIDE","3 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","DONEPEZIL HYDROCHLORIDE","5 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","250 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100 MG","","Select","Select",""],["","","Atenolol Tab","50 MG","","Select","Select",""],["","","Budesonide Cap","3 MG","","Select","Select",""],["","","Levothyroxin Tab","100 MCG","","Select","Select",""],["","","Donepezil Tab","5 MG","","Select","Select",""],["","","Doxycycl Hyc Tab","100 MG","","Select","Select",""],["","","Escitalopram Tab","10 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Lisinopril Tab","20 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Tizanidine Tab","2 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Amlodipine Tab","2.5 MG","","Select","Select",""],["","","Atorvastatin Tab","80 MG","","Select","Select",""],["","","Lisinop\/Hctz Tab 20-12.5","","","Select","Select",""],["","","Trazodone Tab","50 MG","","Select","Select",""],["","","Zolpidem Tab","5 MG","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","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":""}]}]}