{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY SIMMONS","gend":1,"currentgend":"","add":"200 OAK ST","city":"OVERBROOK","state":"KS","zip":"66524","dob":"1963-03-31","age":"","mstatus":"","insh":"K44006368","cliId":"","pno":"7856657219","cno":"7856653234","email":"","ename":"","eno":"","pphy":"JENNA WEEKLEY","ppno":"7858367111","pcpadd":"211 E MAIN ST","pcpcity":"CARBONDALE","pcpstate":"KS","pcpzip":"66414-9607","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"UNIT 5","add3":"","madd1":"200 OAK ST","madd2":"UNIT 5","madd3":"","mcity":"OVERBROOK","mstate":"KS","mzip":"66524","pcpfaxno":"","pcpnpi":"1699342915","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006368","medicareid":"1P85N92MP98","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R569","J418","F17210","F1911","E782","E559","D649","E871","F1010","J4520","E538","Z01818","Z87820","R8281","S52502D","S6992XD","J441","R296","R55","W19XXXA","S8251XA","S82301A","K5730","J439","F1020","R0602","M7989","R82998","W1839XA","Y929","Z98890","B9620","J449","S069X0D","S82851D","R7989","L249","Z0000","L304","R000","R051","E162","S82891D","M6281","R488","Z9181","S93431A","S82851A","G8918","S91002D","J4489","F1290","K219","Z885","R278"],"date":["2025-12-08","2025-03-10","2026-01-19","2025-12-08","2025-12-18","2025-12-04","2024-03-19","2025-11-30","2025-12-11","2025-12-08","2025-12-08","2025-12-08","2025-12-18","2025-12-08","2025-11-25","2025-11-25","2025-12-26","2025-11-30","2025-11-30","2025-12-01","2025-12-01","2025-12-01","2025-11-30","2025-11-30","2025-11-30","2025-11-30","2025-11-30","2025-11-30","2025-11-30","2025-11-30","2025-12-07","2025-12-07","2025-12-11","2025-12-11","2025-12-11","2025-12-26","2025-12-29","2025-03-10","2025-03-10","2025-03-10","2025-03-10","2025-03-10","2026-05-31","2026-05-31","2026-02-18","2026-02-18","2026-01-19","2026-01-19","2026-01-19","2026-05-07","2026-01-19","2026-01-19","2026-01-19","2026-01-19","2026-05-31"],"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":[["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","DONEPEZIL HCL","10 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE\/SALMETEROL","","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","CLOTRIMAZOLE","1%","","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":""}]}]}