{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRED M DAVIS","gend":0,"currentgend":"","add":"2367 20TH RD","city":"WAVERLY","state":"KS","zip":"66871","age":"","mstatus":"","insh":"K44006171","cliId":"","pno":"7852419796","cno":"","email":"fmd122867@hotmail.com","ename":"","eno":"","pphy":"ASHLEY MOODY","ppno":"7855372651","pcpadd":"3520 SW 6TH AVE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66502-5000","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1386363273","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006171","medicareid":"6J77A70XD50","medicaidid":"6J77A70XD50","pcpFlag":"","dob":"1967-12-28"},{"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":["Z96642","S82832A","E6609","D72829","S92342A","M216X2","S82232D","M7989","R7401","R7309","R748","W19XXXA","Y929","G4733","G40909","T796XXA","I10","S82302A","W010XXA","S82872A","R600","W1839XA","Y9389","Y9273","Y998","S82872D","S82832D","G8918","E669","S82822D","R7303","Z87310","M85872","M85862","S72412D","R7989","Z13820","M25562","Z98890","E6601","S82302D","S82002D","E7800","Z760","Z125","S72422A","Z6841","Z1152","Z79899","Z751","S72402A","Z6839","G4730","R569","T796XXD","E785","S50902D","L24A0","K5900","S72422D","M25069","Z8781","Z9181","Z993","Z9989","E119","M810","N134","K8020","K5730","R1032","L918","D2362","L821","L814","W57XXXA","R61","Z87442","E291","D1801","L578","D235","Z808","N401","R351","E1165"],"date":["2024-01-05","2024-06-28","2024-04-13","2024-07-10","2024-04-07","2024-04-07","2024-04-07","2024-05-29","2024-04-07","2024-04-07","2024-04-07","2024-04-22","2024-04-07","2026-06-02","2026-01-21","2024-04-30","2026-01-21","2024-09-03","2024-04-08","2024-04-08","2024-04-07","2024-04-07","2024-04-07","2024-04-07","2024-04-07","2024-09-24","2024-11-05","2024-04-08","2024-07-10","2024-05-29","2024-11-04","2025-02-11","2024-05-29","2024-05-29","2024-08-13","2026-05-27","2024-06-28","2024-09-24","2024-09-24","2026-06-02","2024-11-05","2024-11-05","2026-01-21","2026-01-21","2024-03-29","2024-04-07","2026-01-27","2024-04-07","2024-04-07","2024-04-07","2024-04-22","2024-07-10","2024-04-22","2024-04-22","2024-07-10","2024-07-10","2024-04-13","2024-04-13","2024-04-13","2024-07-10","2024-07-10","2024-07-10","2024-07-10","2024-07-10","2024-07-10","2024-12-18","2026-05-27","2025-08-28","2025-08-28","2025-08-28","2025-08-04","2025-05-19","2025-05-19","2025-05-19","2026-05-20","2025-05-19","2025-08-28","2025-08-28","2026-01-27","2026-05-20","2026-05-20","2026-05-20","2026-05-20","2026-01-21","2026-01-21","2026-01-21"],"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":[["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","OZEMPIC","4 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","CARBAMAZEPINE","200 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","FLUCELVAX 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":""}]}]}