{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID A BEAUMONT","gend":0,"currentgend":"","add":"516 E Lewerenz St","city":"Herington","state":"KS","zip":"67449","age":"","mstatus":"","insh":"K44006121","cliId":"","pno":"7852143126","cno":"","email":"d.beaumont@sbcglobal.net","ename":"","eno":"","pphy":"EMILY EBERT","ppno":"3167339355","pcpadd":"200 RESEARCH DR","pcpcity":"MANHATTAN","pcpstate":"KS","pcpzip":"67002-7919","pcpcounty":"","pcpid":"","pcpname":"MANHATTAN MEDICAL GROUP LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1780300848","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006121","medicareid":"9GK4AH4HA67","medicaidid":"9GK4AH4HA67","pcpFlag":"","dob":"1948-05-12"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["E785","I2510","I10","I77810","I83893","R600","Z139","R0602","R8290","J9811","R748","R5383","R918","R9389","M6281","M6282","N1831","I129","R7301","E663","J8410","K449","K219","J479","R051","R509","A419","J9601","N179","E8720","D72825","E8729","E871","J121","Z8739","E559","J189","Z79899","N261","R3129","I4720","G479","Z23","A403","J13","J869","R6520","I5032","E876","Z20822","I110","R5381","M109","Z7982","Z955","Z888","E861","N182","Z6830","E7849","N189","Z6829","E669","R7881","J90","Z01818","J210","N289","E875","D75839","Z98890","B955","B953","J22","R6521","Z4682","Z8619","Z2911","E782","Z6826","R7309","N1830","R7303","T380X5A","B9689","Z789","Z6828","K5900","Z4802","D649","L282","D631","Z6832","I5189","Z7984","I2583","Z7902","I517","I080","R001","R7401","I214","I130","R9431","R7989","I7121","Z604","F439","I252","R079","Z8701","Z8679"],"date":["2026-06-02","2026-05-19","2026-06-02","2026-04-21","2025-01-07","2025-02-26","2026-05-05","2026-04-16","2024-07-18","2025-01-14","2024-08-16","2025-01-21","2025-02-06","2024-08-16","2024-08-16","2025-02-26","2026-05-05","2026-05-18","2026-03-18","2026-03-18","2026-05-05","2025-04-03","2026-04-16","2024-09-24","2024-12-26","2024-12-30","2025-01-15","2025-01-15","2025-01-10","2025-01-10","2025-01-01","2025-01-01","2025-01-10","2025-01-01","2026-04-16","2025-05-28","2026-04-21","2026-05-18","2024-08-16","2024-08-16","2025-11-21","2024-09-27","2024-11-01","2025-01-10","2025-01-14","2025-01-15","2025-01-07","2026-04-21","2024-12-30","2026-04-16","2024-12-30","2025-01-21","2026-04-21","2026-05-19","2026-04-16","2026-04-16","2024-12-30","2025-09-09","2026-03-18","2026-03-18","2026-05-18","2025-09-17","2025-12-17","2025-01-15","2025-02-06","2025-01-09","2025-01-15","2025-01-15","2025-01-15","2025-01-15","2025-01-12","2025-01-07","2025-01-15","2025-01-15","2025-01-15","2025-01-14","2025-01-21","2025-01-07","2026-04-30","2025-02-26","2025-06-26","2026-04-21","2025-01-07","2025-01-07","2025-01-07","2025-01-07","2025-01-21","2025-01-21","2025-01-21","2025-02-21","2025-02-21","2025-05-28","2025-05-21","2026-02-09","2026-03-18","2026-04-17","2026-05-19","2026-04-20","2026-04-17","2026-06-02","2026-04-21","2026-04-21","2026-04-21","2026-05-19","2026-04-16","2026-04-16","2026-04-16","2026-04-16","2026-04-16","2026-04-16","2026-04-30","2026-05-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","METOPROLOL TARTRATE","25 MG","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","20 MG","","Select","Select",""],["","","EZETIMIBE","10 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","5 MG","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","JARDIANCE","10 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","KETOCONAZOLE","2%","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 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":""}]}]}