{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUZANNE P LARA","gend":1,"currentgend":"","add":"2920 KAREN CT","city":"SALINA","state":"KS","zip":"67401","dob":"1947-07-15","age":"","mstatus":"","insh":"K44005608","cliId":"","pno":"7852184303","cno":"","email":"suzi.que747@gmail.com","ename":"","eno":"","pphy":"DANA KNOX","ppno":"3165007549","pcpadd":"101 INDUSTRIAL RD","pcpcity":"HILLSBORO","pcpstate":"KS","pcpzip":"67218-1180","pcpcounty":"","pcpid":"","pcpname":"PRAIRIESTAR HEALTH CENTER","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2920 KAREN CT","madd2":"","madd3":"","mcity":"SALINA","mstate":"KS","mzip":"674017818","pcpfaxno":"","pcpnpi":"1285224907","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44005608","medicareid":"1NX4Y06FC50","medicaidid":"1NX4Y06FC50","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5112","R7303","G3184","M8580","R5383","Z5111","Z87891","S8264XA","M25571","R262","I10","E785","E559","C9000","M7021","F0390","C9001","E782","Z7689","Z6825","R928","Z6823","T7840XA","L299","Z23","R8290"],"date":["2026-06-19","2024-10-31","2024-11-08","2024-05-08","2024-06-20","2024-06-20","2024-08-15","2024-08-15","2024-09-11","2024-10-03","2026-06-03","2024-10-31","2024-10-31","2024-11-08","2025-12-04","2026-06-03","2025-02-05","2025-02-05","2025-02-05","2025-02-05","2025-02-05","2025-12-05","2025-10-31","2025-12-05","2026-06-03","2026-06-03"],"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":[["","","DONEPEZIL HYDROCHLORIDE","5 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","DEXAMETHASONE","4 MG","","Select","Select",""],["","","ACYCLOVIR","200 MG","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE AUGMENTED","0.05%","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","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":""}]}]}