{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDITH S SCHERFF","gend":1,"currentgend":"","add":"2640 SE FLORA CT","city":"TOPEKA","state":"KS","zip":"66605","dob":"1939-10-02","age":"","mstatus":"","insh":"K44005173","cliId":"","pno":"7852665291","cno":"","email":"CHAW@COX.NET","ename":"","eno":"","pphy":"LEANNE FINNEY","ppno":"7859549591","pcpadd":"823 SW MULVANE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1764","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1396073201","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44005173","medicareid":"2N06PY9XK66","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M546","M9901","M542","M9903","M5451","J3089","Z950","E7800","R5383","M109","R21","N3946","I872","N3281","Z8619","I4891","I4892","I480","I495","I4710","Z7901","M2550","W57XXXD","W57XXXA","R110","G4700","I10","J301","R5382","I491","R001","Z0000","Z87892","Z96641","R55","I2720","Z87891","Z79899","I2721","M79642","M79641","M19042","R319","N3000","K625","M19041","R52","M2560","M6281","Z789","G4733","R739","R079","Z780","M9904","M9905","Z13820","Z7689","E559","Z961","H5231","H52223","M9902","M79604","R4189","R2689","B351","M79605","S4991XA","H5212","H5319"],"date":["2026-06-19","2026-06-19","2026-06-19","2026-06-19","2026-06-19","2024-01-26","2025-12-28","2025-12-28","2026-05-04","2024-03-28","2024-03-28","2024-03-28","2026-04-06","2026-06-04","2026-05-04","2025-09-28","2025-12-28","2026-04-06","2025-12-28","2025-12-28","2025-09-28","2024-03-28","2024-04-10","2026-05-04","2024-04-09","2024-04-24","2025-10-31","2024-08-19","2025-12-28","2025-12-28","2025-12-28","2024-09-30","2024-09-30","2024-11-19","2024-08-29","2024-02-01","2024-02-01","2024-09-16","2024-08-29","2025-07-23","2025-07-23","2025-09-08","2025-07-09","2025-07-09","2025-07-09","2025-09-08","2025-09-08","2025-09-08","2025-09-08","2025-09-08","2026-04-06","2025-10-09","2025-10-06","2025-10-29","2026-06-19","2026-06-19","2025-10-29","2025-12-28","2026-04-06","2026-05-14","2025-05-06","2026-05-14","2025-05-28","2026-04-06","2026-04-06","2026-04-06","2026-04-06","2026-04-06","2026-04-28","2026-05-14","2026-05-14"],"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":[["","","AZITHROMYCIN","500 MG","","Select","Select",""],["","","CICLOPIROX NAIL LACQUER","8%","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","DILTIAZEM HYDROCHLORIDE ER","120 MG","","Select","Select",""],["","","RESTASIS","0.05%","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","MYRBETRIQ","50 MG","","Select","Select",""],["","","PROPRANOLOL HYDROCHLORIDE","10 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","CEFUROXIME AXETIL","500 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","250 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 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":""}]}]}