{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA J SCHELL","gend":1,"currentgend":"","add":"5603 FOXCROFT CIRCLE S","city":"TOPEKA","state":"KS","zip":"66614","age":"","mstatus":"","insh":"K44003941","cliId":"","pno":"7852245590","cno":"","email":"vschell1@cox.net","ename":"","eno":"","pphy":"ANGELA DEPPERSCHMIDT","ppno":"7852670744","pcpadd":"823 MULVANE ST","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66605-2189","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT 106","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1588177984","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003941","medicareid":"6Q81WJ4AU12","medicaidid":"6Q81WJ4AU12","pcpFlag":"","dob":"1952-08-31"},{"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":["R7989","K760","M159","B009","D84821","E6609","Z780","Z1231","Z0000","Z79899","Z6836","M150","M5442","M9904","M9905","M9902","M9901","Z6841","Z13228","Z1329","Z13220","G4733","M069","M79642","H43822","R92333","Z13820","M170","E66812"],"date":["2024-06-05","2026-06-05","2024-08-20","2024-08-28","2024-08-28","2026-06-05","2024-08-28","2024-08-28","2026-06-05","2024-08-28","2026-06-05","2026-06-03","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2025-11-14","2025-11-14","2025-11-14","2025-11-14","2026-05-05","2025-03-07","2025-02-05","2025-03-04","2026-03-09","2025-03-07","2026-06-03","2026-06-05"],"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":[["","","PREDNISONE","5 MG","","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","300 MG","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4 MG","","Select","Select",""],["","","Clindamycin Cap","300 MG","","Select","Select",""],["","","Fluad Inj 2025-26","","","Select","Select",""],["","","Tizanidine Tab","4 MG","","Select","Select",""],["","","Prednisone Tab","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":""}]}]}