{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTY G SMITH","gend":1,"currentgend":"","add":"500 E LA MESA ST","city":"DERBY","state":"KS","zip":"67037","age":"","mstatus":"","insh":"K44004271","cliId":"","pno":"3167089539","cno":"","email":"smiths5257@sbcglobal.net","ename":"","eno":"","pphy":"MALISSA PAXTON","ppno":"3167883787","pcpadd":"606 N MULBERRY RD","pcpcity":"DERBY","pcpstate":"KS","pcpzip":"67037-3532","pcpcounty":"","pcpid":"","pcpname":"TANGLEWOOD FAMILY MED CTR","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"500 E LA MESA ST","madd2":"","madd3":"","mcity":"DERBY","mstate":"KS","mzip":"67037","pcpfaxno":"","pcpnpi":"1144321902","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44004271","medicareid":"5RM9HK9FA47","medicaidid":"5RM9HK9FA47","pcpFlag":"","dob":"1957-06-11"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E782","E039","E559","Z90710","Z87440","Z8041","R5383","E031","M8580","L570","M2011","N398","M542","Z1331","N952","N762","Z79890","R300","N760"],"date":["2025-08-07","2024-08-07","2025-09-05","2024-08-23","2024-08-23","2024-08-23","2025-09-05","2025-09-08","2025-09-08","2024-08-07","2024-12-19","2025-09-05","2025-09-08","2025-09-08","2026-04-14","2025-08-27","2025-08-27","2026-04-14","2026-03-10"],"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":[["","","DIGOXIN","0.125 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","MELOXICAM","7.5 MG","","Select","Select",""],["","","NYSTATIN\/TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","TERCONAZOLE","0.40%","","Select","Select",""],["","","ESTRADIOL","1 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","75 MCG","","Select","Select",""],["","","MONTELUKAST SODIUM","10 MG","","Select","Select",""],["","","CEPHALEXIN","250 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100 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":""}]}]}