{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY M PACKARD","gend":1,"currentgend":"","add":"3650 SW HOLLY LN","city":"TOPEKA","state":"KS","zip":"66604","dob":"1974-12-12","age":"","mstatus":"","insh":"K44005678","cliId":"","pno":"7856336755","cno":"","email":"amy.packard74@gmail.com","ename":"","eno":"","pphy":"KAREN BRUCE","ppno":"7852331747","pcpadd":"601 SW CORPORATE VIEW","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1696","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3650 SW HOLLY LN","madd2":"","madd3":"","mcity":"TOPEKA","mstate":"KS","mzip":"66604","pcpfaxno":"","pcpnpi":"1831298462","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44005678","medicareid":"7JY4QE6AV03","medicaidid":"7JY4QE6AV03","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I639","F411","Z8673","H25013","H2513","H5213","H52223","H524","R42","G8111","I10","E782","G4733","R4789","R29818","R29810","R29898","R82998","R946","E1165","Z794","E876","E041","E871","I6389","I63511","R4781","M6281","E042","M5450","G8929","E6601","Z6841","E559","E119","E11649","Z95818","E1159","S4991XA","R5383","R296","R112","R944","R7401","R791","Z87891","R531","Z742","Z23","N179","Z90710","Z789","I69351","R748","E8342","F331","R471","E785","R4701","F32A","R252","R339","I69322","Z7984","G8191","R6889","K219","I6381","E1140","F321","I161","E669","G8194","Z6842","Z20822","Z5941","Z888","Z5986","Z7985","Z7902","Z79899","I69320","Z9181","Z7982","Z7409","R4189","I69398","R261","F418","R159","R32","Z466","I69998","D649","R92323","Z803","M21371","Z0000","E66813","F330","E66812","E6609","Z6835","F339","Z9989","I480","Z98890","I4891","Z7901"],"date":["2026-05-25","2026-05-18","2026-03-24","2024-02-28","2024-02-28","2025-02-28","2025-02-28","2025-02-28","2024-12-03","2026-05-18","2026-05-18","2026-05-18","2026-05-18","2024-09-08","2024-09-08","2024-04-16","2024-04-16","2024-09-08","2024-04-16","2026-02-17","2025-09-29","2024-10-04","2024-04-18","2024-05-02","2024-04-16","2024-04-16","2024-07-14","2024-12-23","2026-02-17","2024-09-04","2024-09-04","2024-11-13","2025-06-03","2024-09-03","2024-11-13","2024-07-16","2024-08-28","2024-07-16","2024-07-14","2024-07-14","2024-09-10","2024-09-13","2024-09-08","2024-09-08","2024-07-14","2024-11-13","2024-12-23","2024-10-17","2024-09-04","2024-09-13","2024-09-13","2024-12-23","2024-10-04","2024-09-08","2024-09-10","2025-01-20","2024-09-10","2024-09-14","2024-10-04","2024-11-13","2024-11-06","2024-09-28","2024-11-13","2025-12-18","2024-12-23","2024-11-14","2024-12-03","2024-04-16","2024-04-16","2024-04-16","2024-04-16","2024-09-10","2024-04-16","2024-09-10","2024-09-10","2024-07-16","2024-04-16","2024-07-16","2025-12-18","2024-09-10","2024-11-13","2024-08-28","2024-11-13","2024-11-13","2024-09-10","2024-09-10","2024-09-13","2024-09-13","2024-09-13","2024-09-13","2024-09-13","2024-09-13","2024-11-13","2024-11-13","2025-06-16","2025-06-16","2025-09-25","2025-12-03","2025-06-03","2026-02-19","2026-02-17","2026-02-17","2026-02-17","2026-05-18","2026-02-17","2026-03-19","2026-03-19","2026-05-07","2026-05-07"],"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":[["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","MIRTAZAPINE ODT","15 MG","","Select","Select",""],["","","MOUNJARO","10 MG","","Select","Select",""],["","","CARVEDILOL","25 MG","","Select","Select",""],["","","FLUOXETINE HYDROCHLORIDE","40 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","150 MG","","Select","Select",""],["","","ASPIRIN\/DIPYRIDAMOLE ER","200 MG","","Select","Select",""],["","","VRAYLAR","3 MG","","Select","Select",""],["","","FENOFIBRATE","145 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","80 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","OZEMPIC","8 MG","","Select","Select",""],["","","GABAPENTIN","800 MG","","Select","Select",""],["","","MECLIZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","Fluoxetine Cap","40 MG","","Select","Select",""],["","","Meclizine Tab","25 MG","","Select","Select",""],["","","Mounjaro Inj 12.5\/0.5","","","Select","Select",""],["","","Mirtazapine Tab","15 MG","","Select","Select",""],["","","Carvedilol Tab","25 MG","","Select","Select",""],["","","Vraylar Cap","3 MG","","Select","Select",""],["","","Asa\/Dipyrida Cap 25-200Mg","","","Select","Select",""],["","","Mounjaro Inj","5 MG","","Select","Select",""],["","","Baclofen Tab","10 MG","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Dexcom G6 Mis Sensor","","","Select","Select",""],["","","Lisinopril Tab","40 MG","","Select","Select",""],["","","Dexcom G6 Mis Transmit","","","Select","Select",""],["","","Mounjaro Inj 7.5\/0.5","","","Select","Select",""],["","","Ozempic Inj","8 MG","","Select","Select",""],["","","Amlodipine Tab","2.5 MG","","Select","Select",""],["","","Bupropion Tab","150 MG","","Select","Select",""],["","","Atorvastatin Tab","80 MG","","Select","Select",""],["","","Gabapentin Tab","800 MG","","Select","Select",""],["","","Fenofibrate Tab","145 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":""}]}]}