{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERRY J POLLARD","gend":0,"currentgend":"","add":"709 MAPLE ST","city":"WAMEGO","state":"KS","zip":"66547","dob":"1953-01-09","age":"","mstatus":"","insh":"K44006056","cliId":"","pno":"2818318063","cno":"","email":"berryedita@gmail.com","ename":"","eno":"","pphy":"ERIKA SHAW","ppno":"7855394644","pcpadd":"200 RESEARCH DR","pcpcity":"MANHATTAN","pcpstate":"KS","pcpzip":"66503-3049","pcpcounty":"","pcpid":"","pcpname":"MANHATTAN MEDICAL GROUP LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"709 MAPLE ST","madd2":"","madd3":"","mcity":"WAMEGO","mstate":"KS","mzip":"66547","pcpfaxno":"","pcpnpi":"1750147799","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006056","medicareid":"3K19C89QY58","medicaidid":"3K19C89QY58","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D120","D122","Z86010","I10","I2510","E0590","I340","I361","I77810","E119","I4710","I5020","I509","G4700","I351","I514","E039","E782","Z125","I252","I480","I4729","Z8719","Z8711","K429","K317","K5730","I5022","G4733","I110","R931","J986","K3189","J90","Z48812","R0602","Z952","I455","Z95818","I493","R001","R9431","I371","Z955","I130","I77819","N189","Z7982","Z7901","Z79899","I4891","Z7902","Z800","D62","I4892","E1165","D72829","I6523","R0902","Z860100","Z7984","Z9229","I499","R600","J9811","I5189","I495","Z4509","Z950"],"date":["2024-01-08","2024-01-08","2024-09-06","2026-02-17","2024-11-22","2024-02-12","2024-12-26","2025-04-22","2025-04-22","2024-08-12","2024-03-08","2026-05-07","2024-09-10","2024-05-20","2025-01-10","2024-05-22","2026-02-16","2024-11-11","2024-08-12","2024-11-11","2026-05-19","2024-09-10","2024-09-06","2024-09-06","2024-09-06","2024-09-06","2024-09-06","2024-11-11","2024-11-11","2024-11-11","2024-11-11","2024-11-12","2024-11-12","2024-11-11","2024-11-14","2024-11-12","2026-05-19","2026-04-16","2026-02-17","2024-12-12","2026-02-16","2026-05-07","2024-12-26","2024-11-11","2024-05-13","2024-05-13","2024-05-13","2024-11-11","2025-02-14","2025-01-29","2024-09-06","2024-11-11","2024-09-06","2024-11-11","2024-11-11","2024-11-11","2024-11-11","2024-11-11","2024-11-11","2024-11-11","2024-11-11","2025-01-10","2025-02-10","2025-06-03","2026-04-16","2025-04-22","2026-05-07","2026-04-15","2026-05-19"],"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":[["","","FARXIGA","10 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","ENTRESTO","103 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","103 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","DAPAGLIFLOZIN","10 MG","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","CONTOUR NEXT EZ BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","Farxiga Tab","10 MG","","Select","Select",""],["","","Furosemide Tab","40 MG","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Pot Chloride Tab","20 MEQ","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Contour Tes Next","","","Select","Select",""],["","","Metoprol Suc Tab","25 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Entresto Tab 97-103Mg","","","Select","Select",""],["","","Sacub\/Valsar Tab 97-103Mg","","","Select","Select",""],["","","Atorvastatin Tab","40 MG","","Select","Select",""],["","","Contour Kit Next Ez","","","Select","Select",""],["","","Eliquis Tab","5 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":""}]}]}