{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAHANN GUFFY","gend":1,"currentgend":"","add":"3301 SW 29th Ter","city":"Topeka","state":"KS","zip":"66614","age":"","mstatus":"","insh":"K44004624","cliId":"","pno":"7856700525","cno":"7856700525","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44004624","medicareid":"9U18CT9NU45","medicaidid":"","pcpFlag":"","dob":"1939-11-19"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R519","G8929","I10","K219","F32A","M1612","R9431","I517","Z95818","C20","G2581","M542","Z7902","E782","R0602","I480","Z006","E785","Z7901","G4733","I2720","R296","Z79899","Z91048","Z98890","Z888","Z539","I110","I5030","I4729","G4700","E611","I4891","I5032","G44311","Z1329","Z130","M51360","Z933","Z85038","F331","R799","M47816","M4316","M48061","Z13220","Z1389","R4182","M7731","M79661","M7989","W19XXXA","M47817","R918","M19011","I5042","I120","G4719","E559","R42","I4819","M25571","I130","N189","M4317","N179","I132","N186","I3481","J439","G250","D485","L821","L853","N3941","R350","R351","F1020","R7303","R251","I081","Z7982"],"date":["2026-06-17","2025-08-22","2025-08-06","2025-07-28","2025-07-28","2025-07-28","2025-09-17","2025-09-18","2026-03-16","2026-03-30","2026-06-17","2026-01-28","2026-03-23","2026-06-19","2025-11-18","2026-06-17","2025-07-28","2026-03-23","2025-09-15","2026-06-17","2026-03-16","2025-09-17","2026-03-23","2025-07-28","2025-07-28","2025-07-28","2025-09-15","2026-03-23","2025-09-17","2025-09-17","2025-07-09","2025-07-09","2025-07-28","2025-08-06","2025-08-06","2025-04-15","2025-04-15","2026-06-17","2026-06-17","2026-06-17","2026-06-17","2025-04-15","2025-02-28","2025-02-28","2025-04-15","2025-04-15","2025-04-15","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-15","2025-05-20","2025-05-20","2026-06-17","2025-05-20","2025-06-13","2025-06-13","2025-06-16","2025-08-06","2025-04-08","2025-04-17","2025-04-17","2025-04-15","2025-04-17","2025-05-20","2025-05-20","2025-05-20","2025-05-20","2026-01-28","2026-02-18","2026-02-18","2026-02-18","2026-03-31","2026-03-31","2026-03-31","2026-04-14","2026-06-17","2026-02-12","2026-03-16","2026-03-23"],"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":[["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","TWINRIX","","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","50 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","VENLAFAXINE HYDROCHLORIDE ER","150 MG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","ROPINIROLE HYDROCHLORIDE","0.5 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","KETOCONAZOLE","2%","","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":""}]}]}