{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NANCY J LAWRENCE","gend":1,"currentgend":"","add":"628 SW Grandview Ave","city":"Topeka","state":"KS","zip":"66606","dob":"1955-11-08","age":"","mstatus":"","insh":"K44006514","cliId":"","pno":"7852497037","cno":"","email":"NJBLAWRENCE@AOL.COM","ename":"","eno":"","pphy":"MELISSA HERRMAN","ppno":"7852331747","pcpadd":"4505 NW FIELDING RD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1696","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"628 SW Grandview Ave","madd2":"","madd3":"","mcity":"Topeka","mstate":"KS","mzip":"66606","pcpfaxno":"","pcpnpi":"1184750796","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006514","medicareid":"3G38YM1CN32","medicaidid":"3G38YM1CN32","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":["I10","L089","I480","S72002A","E801","E1169","M25552","D72829","R7309","Z7901","W1839XA","Y9301","Y929","E119","E785","Z8249","Z79899","Z98890","I440","I088","I4891","I517","Z8781","Z8679","R195","S72012A","E1165","T380X5A","Z85828","Z8616","Z9049","Z90710","Z7984","Z885","Z888","M546","I4819","G8929","R001","Z0000","R0981","R92333","Z803","R92323"],"date":["2025-10-08","2024-02-13","2024-05-28","2024-05-28","2025-07-16","2024-12-05","2026-06-19","2024-06-04","2024-05-25","2025-09-08","2024-05-25","2024-05-25","2024-05-25","2024-11-20","2025-10-08","2024-07-17","2024-11-20","2025-09-08","2024-11-22","2024-11-22","2024-11-22","2024-11-22","2024-11-25","2025-09-08","2024-12-05","2024-05-25","2024-05-25","2024-05-25","2024-11-20","2024-05-25","2024-05-25","2024-05-25","2025-12-18","2024-11-20","2024-11-20","2025-07-16","2025-12-18","2025-07-16","2025-09-08","2025-12-18","2025-12-18","2025-01-21","2026-01-27","2026-01-27"],"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":[["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","CLONIDINE HYDROCHLORIDE","0.1 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","BENAZEPRIL HYDROCHLORIDE","40 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","XARELTO","20 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","BENAZEPRIL HCL","40 MG","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","CONTOUR NEXT GEN BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MICROLET LANCETS","","","Select","Select",""],["","","SPIKEVAX COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","Clonidine Tab","0.1 MG","","Select","Select",""],["","","Xarelto Tab","20 MG","","Select","Select",""],["","","Microlet Mis Lancets","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Benazepril Tab","40 MG","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Contour Tes Next","","","Select","Select",""],["","","Spikevax Inj 2025-26","","","Select","Select",""],["","","Contour Next Kit Gen","","","Select","Select",""],["","","Eliquis Tab","5 MG","","Select","Select",""],["","","Amlodipine Tab","10 MG","","Select","Select",""],["","","Atorvastatin Tab","20 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":""}]}]}