{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD L ROACH","gend":0,"currentgend":"","add":"2932 SW BREWSTER CT","city":"TOPEKA","state":"KS","zip":"666111166","age":"","mstatus":"","insh":"K44006354","cliId":"","pno":"7855545447","cno":"","email":"CAR_MAN1941@YAHOO.COM","ename":"","eno":"","pphy":"STEVEN TAKI","ppno":"7853546000","pcpadd":"1133 SW TOPEKA BLVD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66604-1301","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":"1659805992","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006354","medicareid":"8R91VC6WQ29","medicaidid":"","pcpFlag":"","dob":"1933-05-16"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1151","E1165","Z1331","Z1339","N1831","I10","E785","K5909","E1121","I2720","S065XAA","D631","R1030","R531","R112","R6889","Z7984","M8588","Z9049","L02612","B351","L84","E1122","N1830","E875","H401132","N3289","N1330","Z794","K921","Z8711","K253","K648","K5730","N1339","K644","D72829","D649","R944","Z87891","N4889","T839XXA","R82998","R7309","Y929","R195","R1084","R339","N189","E119","Z978","D62","I129","Z09","K449","G4719","R102","R109","J982","E11628","E11622","E440","G8918","Z681","L89313","N401","R338","L89319","G4700","R7401","N390","G8929","M542","K649","Z466","H401131","Z961","Z872","L570","R5383","R3981","R600","L603","L608","Z0130","R32","M7989","Z136","Z0000","Z66","N400","R636","Z885","H401130","M5412","L98412","Z7409","Z960","T83511A","L89323","R918","G4710","R634","N1832","R1319","I499","I4891","R0689","J189","I491","R29818","Z7189","L8993","Z8701","L89153","E639","S51811A","S61511A","S51812A"],"date":["2024-08-28","2026-04-28","2026-04-28","2026-04-28","2026-04-28","2026-05-21","2025-07-15","2026-03-17","2025-04-24","2026-04-28","2024-04-24","2026-04-28","2024-07-31","2026-04-22","2024-07-31","2024-07-31","2026-04-28","2024-07-31","2025-07-13","2024-08-28","2024-11-13","2024-11-13","2026-04-28","2025-08-27","2025-07-15","2025-07-15","2025-07-15","2025-07-15","2025-07-13","2025-07-13","2025-07-13","2025-07-15","2026-02-17","2025-07-15","2025-07-11","2026-01-27","2025-07-19","2025-07-11","2026-03-16","2026-05-28","2025-07-19","2025-07-19","2026-03-16","2025-07-19","2025-07-19","2025-07-25","2025-09-28","2026-05-06","2025-07-25","2026-03-30","2026-06-15","2025-07-28","2025-07-28","2025-07-28","2025-07-14","2025-09-16","2025-09-28","2025-09-28","2025-09-28","2025-09-08","2025-11-11","2026-06-02","2025-11-11","2026-06-02","2025-08-27","2026-04-09","2026-05-28","2025-08-24","2025-09-16","2025-09-28","2025-12-02","2025-10-28","2026-04-09","2025-12-02","2026-05-27","2025-09-24","2026-04-01","2025-12-02","2025-11-19","2025-03-10","2025-03-10","2025-03-10","2026-03-30","2026-03-30","2025-03-28","2025-03-28","2025-03-28","2025-04-24","2026-04-28","2025-07-13","2025-07-13","2025-07-13","2025-07-13","2025-07-13","2025-07-13","2025-11-11","2025-10-30","2026-05-28","2025-10-30","2025-12-02","2026-02-17","2026-02-17","2026-03-24","2026-03-11","2026-03-11","2026-03-11","2026-03-16","2026-03-11","2026-03-11","2026-03-11","2026-03-16","2026-04-28","2026-04-09","2026-05-28","2026-05-06","2026-05-06","2026-05-28","2026-05-28","2026-05-28"],"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":[["","","SILVER SULFADIAZINE","1%","","Select","Select",""],["","","FARXIGA","10 MG","","Select","Select",""],["","","GLIPIZIDE ER","2.5 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","PIOGLITAZONE HCL","45 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","20 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","LINZESS","145 MCG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","GENTAMICIN SULFATE","0.10%","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","DAPAGLIFLOZIN PROPANEDIOL","10 MG","","Select","Select",""],["","","DAPAGLIFLOZIN","10 MG","","Select","Select",""],["","","MUPIROCIN","2%","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","COMIRNATY 2024-25","","","Select","Select",""],["","","DORZOLAMIDE HCL\/TIMOLOL MALEATE","","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","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":""}]}]}