{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LANCE E WILLITS","gend":0,"currentgend":"","add":"117 S VILLAGE TER","city":"TONGANOXIE","state":"KS","zip":"66086","dob":"1955-03-05","age":"","mstatus":"","insh":"K44006469","cliId":"","pno":"7857270287","cno":"","email":"doggins@rocketmail.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"LMH HEALTH PRIMARY CARE","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"117 S VILLAGE TER","madd2":"","madd3":"","mcity":"TONGANOXIE","mstate":"KS","mzip":"660869102","pcpfaxno":"","pcpnpi":"1336147602","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006469","medicareid":"1T35Y88RG87","medicaidid":"1T35Y88RG87","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":["J441","Z720","H2513","H35372","H4322","H524","R000","F439","L989","M546","M5134","M9903","M5451","M5136","M9901","M542","M5020","J449","R918","F17290","F17210","M5414","Z8616","M810","Z129","E7800","M51360","D539","J432","Z125","H25811","H5703","Z7689","M62830","R251","J4489","D696","D7589","Z23","I700","Z87891","R058","R059","Z59819","Z860101","R0600","D801","Z8679","I5189","M9902","H25043","S39012A","Z1159","I519","S2232XA","M79675","Z961"],"date":["2024-02-28","2025-06-11","2024-05-01","2025-06-02","2026-06-04","2026-06-04","2024-06-10","2024-06-10","2024-07-08","2025-06-11","2025-06-11","2024-12-31","2025-06-11","2024-08-27","2025-06-11","2025-06-11","2025-06-11","2025-06-17","2024-09-30","2025-03-04","2026-04-21","2024-09-30","2024-09-30","2026-04-21","2024-11-14","2024-11-14","2025-06-11","2025-11-05","2024-09-12","2024-11-14","2025-07-14","2025-06-13","2026-04-21","2025-06-11","2025-06-11","2025-06-11","2026-03-03","2026-03-03","2025-11-05","2025-11-05","2025-11-11","2025-02-17","2025-03-17","2025-03-04","2025-03-04","2025-03-04","2025-03-04","2025-04-24","2025-04-24","2025-06-11","2025-06-02","2025-03-17","2025-03-31","2025-04-24","2025-06-11","2026-01-21","2026-06-04"],"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":[["","","KETOROLAC TROMETHAMINE","0.50%","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","MOXIFLOXACIN HYDROCHLORIDE","0.50%","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE\/SALMETEROL DISKUS","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","75 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","200 MCG","","Select","Select",""],["","","VARENICLINE TARTRATE","1 MG","","Select","Select",""],["","","VARENICLINE STARTING MONTH","1 MG","","Select","Select",""],["","","LEVOFLOXACIN","750 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":""}]}]}