{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDY A DE RUSSE","gend":1,"currentgend":"","add":"1115 SW GLENDALE DR","city":"TOPEKA","state":"KS","zip":"666042142","dob":"1937-05-20","age":"","mstatus":"","insh":"K44007027","cliId":"","pno":"7149885149","cno":"","email":"","ename":"","eno":"","pphy":"DEREK FRITZ","ppno":"7852324248","pcpadd":"2840 SW URISH RD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1663","pcpcounty":"","pcpid":"","pcpname":"TOPEKA PHYSICIAN GROUP LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT A","add3":"","madd1":"1115 SW GLENDALE DR","madd2":"APT A","madd3":"","mcity":"TOPEKA","mstate":"KS","mzip":"666042142","pcpfaxno":"7853792457","pcpnpi":"1982264305","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007027","medicareid":"3E62VA1VM24","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G309","Z23","E039","M2559","F0280","Z7689","S0033XA","W19XXXA","L84","B351","M4802","S0240CA","J349","S02401A","R7989","I10","S0083XA","S0240DD","N3000","U071","G250","Z79899","M2550","N393","E66811","Z6830","M8580","R92323","J1282","E8720","E876","E870","F0390","E0590","M810","R634","Z79890","R531","F0283","F32A","M130","Z9181","Z13820","M8589","Z780","Z66","E871","B9620","Z87891","R5383","M150"],"date":["2025-11-26","2025-02-21","2026-02-25","2024-11-11","2026-02-25","2024-11-11","2024-11-14","2025-10-04","2026-03-07","2026-05-09","2025-10-04","2025-10-04","2025-10-04","2025-10-05","2025-10-05","2026-02-25","2025-10-05","2025-11-26","2025-11-26","2025-11-26","2025-01-22","2025-10-05","2025-05-23","2025-02-21","2025-02-21","2025-02-21","2025-03-25","2025-03-25","2025-11-26","2025-04-13","2025-04-13","2025-04-13","2025-04-13","2025-04-07","2026-02-25","2025-11-26","2025-10-05","2025-10-05","2025-11-26","2025-11-26","2025-11-26","2025-11-26","2025-03-25","2025-03-25","2025-03-25","2025-04-07","2025-04-07","2025-04-07","2025-04-07","2025-04-18","2026-02-25"],"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":[["","","DONEPEZIL HCL","10 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","112 MCG","","Select","Select",""],["","","LOPERAMIDE HYDROCHLORIDE","2 MG","","Select","Select",""],["","","MIRTAZAPINE","7.5 MG","","Select","Select",""],["","","LEFLUNOMIDE","10 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","SPIKEVAX COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PROPRANOLOL HYDROCHLORIDE","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":""}]}]}