{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JON P KING","gend":0,"currentgend":"","add":"2718 SW KINGSROW RD","city":"TOPEKA","state":"KS","zip":"66614","dob":"1947-11-20","age":"","mstatus":"","insh":"K44003717","cliId":"","pno":"7852200166","cno":"","email":"jking47ks@gmail.com","ename":"","eno":"","pphy":"IVAN KETTER","ppno":"7852711818","pcpadd":"2641 SW WANAMAKER RD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66614-4971","pcpcounty":"","pcpid":"","pcpname":"TOPEKA PHYSICIAN GROUP LLC","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2718 SW KINGSROW RD","madd2":"","madd3":"","mcity":"TOPEKA","mstate":"KS","mzip":"66614","pcpfaxno":"7853792457","pcpnpi":"1194724500","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003717","medicareid":"4ME5T15XF85","medicaidid":"4ME5T15XF85","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","Z7901","N200","I10","E7800","N1831","I4820","N400","Z87442","Z23","I2510","Z125","E1121","Z809","Z833","Z8249","Z7982","Z79899","N401","K8689","R351","R233","B372","N509","K5730","N281","K449","R600","I739","R350","Z0131","Z0130","R0989","L989","I129","E1122","I700","E785","I4821","E1140","N1830","R160","K7689","Z794","D72829","E1165","E1159","Z7984","Z951","N1832","Z01818","Z87891","E119","Z888","Z8673","R58","Z89512","N132","I160","K7460","F329","I480","M1990","I4510","Z955","S91104D"],"date":["2026-06-05","2026-06-05","2025-09-30","2025-11-03","2026-05-04","2026-05-04","2026-06-05","2025-05-17","2025-05-18","2024-10-31","2025-06-17","2025-11-03","2026-05-04","2024-09-19","2025-05-17","2025-05-17","2025-05-17","2025-10-13","2026-04-23","2025-08-04","2025-11-03","2025-08-12","2025-08-12","2025-08-29","2025-09-30","2025-09-30","2025-09-30","2025-10-13","2025-10-13","2026-04-23","2025-09-08","2025-09-08","2025-03-13","2025-08-10","2025-06-17","2025-06-17","2025-04-21","2025-06-17","2025-05-18","2025-05-18","2025-06-17","2025-05-18","2025-05-17","2025-05-18","2025-05-18","2025-06-03","2025-06-03","2025-06-17","2025-06-03","2025-06-03","2025-06-03","2025-06-17","2025-05-19","2025-06-17","2025-06-17","2025-08-12","2025-04-11","2025-05-17","2025-05-17","2025-05-17","2025-05-17","2025-05-17","2025-05-17","2025-05-17","2025-05-17","2026-04-08"],"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":[["","","FINASTERIDE","5 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE\/BENAZEPRIL HYDROCHLORIDE","20 MG","","Select","Select",""],["","","GLYBURIDE","2.5 MG","","Select","Select",""],["","","CARVEDILOL","6.25 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","60 MG","","Select","Select",""],["","","WARFARIN SODIUM","5 MG","","Select","Select",""],["","","JARDIANCE","10 MG","","Select","Select",""],["","","SHINGRIX","50\/0.5 ML","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE","60 MG","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","FLUCONAZOLE","150 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":""}]}]}