{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANCES L SUMMERS","gend":1,"currentgend":"","add":"820 Ash St","city":"Lyndon","state":"KS","zip":"66451","age":"","mstatus":"","insh":"K44003814","cliId":"","pno":"7856333499","cno":"7857564411","email":"","ename":"","eno":"","pphy":"JEFF SLOYER","ppno":"6203645395","pcpadd":"801 N 4TH ST","pcpcity":"BURLINGTON","pcpstate":"KS","pcpzip":"66839-2616","pcpcounty":"","pcpid":"","pcpname":"COFFEY COUNTY MEDICAL CLINIC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO Box 12","madd2":"","madd3":"","mcity":"Lyndon","mstate":"KS","mzip":"66451","pcpfaxno":"","pcpnpi":"1215931175","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003814","medicareid":"5K53QC7AC05","medicaidid":"5K53QC7AC05","pcpFlag":"","dob":"1938-10-21"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["I493","I491","R519","R9082","M5031","M50321","I872","R42","E782","F419","E039","S50901A","I6501","B351","L84","R262","I10","M25551","R001","E2740","I4891","E871","Z7982","Z792","Z96641","Z9181","Z79899","M5481","R5383","G450","K5900","Z741","K219","L821","R7989","Z23","D649","M542","H8190","I951","M546","M9902","M461","M9904","M5450","M9903","R928","H8113","H31423","H18513","H5213","I6523","J302","G629","R3589","I4819","Z17411","H524","H353132","H04123","D3131","G8194","Z170","Z1721","Z79890","Z1731","R29898","K648"],"date":["2024-04-29","2024-02-05","2026-04-22","2024-01-23","2024-01-23","2024-01-23","2024-02-19","2025-04-11","2024-02-19","2026-04-08","2026-03-27","2024-01-23","2024-06-04","2026-01-20","2025-02-10","2026-01-20","2026-04-22","2024-01-23","2024-01-29","2025-12-16","2024-02-19","2025-10-08","2024-06-19","2024-06-19","2024-06-19","2024-06-19","2026-02-26","2026-03-25","2025-10-08","2025-12-16","2026-04-08","2024-06-19","2024-08-21","2025-05-07","2025-12-16","2025-10-08","2025-10-08","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-07","2026-01-06","2026-01-06","2026-01-06","2025-02-25","2025-04-11","2025-09-23","2026-01-20","2026-04-08","2026-04-08","2026-02-06","2026-05-26","2026-06-08","2026-06-08","2026-06-08","2026-04-22","2026-03-27","2026-03-27","2026-02-26","2026-03-27","2026-04-22","2026-05-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","DILTIAZEM HYDROCHLORIDE ER","60 MG","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","KETOCONAZOLE","2%","","Select","Select",""],["","","LOSARTAN POTASSIUM","25 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","PREMARIN","0.625 MG","","Select","Select",""],["","","CLOTRIMAZOLE","10 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","25 MG","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","ALPRAZOLAM","0.25 MG","","Select","Select",""],["","","DILTIAZEM HCL ER","60 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":""}]}]}