{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICKIE E DONLEY","gend":0,"currentgend":"","add":"2610 FELIX AVE","city":"PARSONS","state":"KS","zip":"67357","age":"","mstatus":"","insh":"K44007143","cliId":"","pno":"3168049024","cno":"","email":"rickied55@yahoo.com","ename":"","eno":"","pphy":"KRISTIN MORGAN","ppno":"6202319873","pcpadd":"3011 N MICHIGAN ST","pcpcity":"PITTSBURG","pcpstate":"KS","pcpzip":"66713-2331","pcpcounty":"","pcpid":"","pcpname":"LCMC PHYSICIANS GROUP","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2610 FELIX AVE","madd2":"","madd3":"","mcity":"PARSONS","mstate":"KS","mzip":"67357","pcpfaxno":"","pcpnpi":"1881045029","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007143","medicareid":"6JX1F42GQ09","medicaidid":"6JX1F42GQ09","pcpFlag":"","dob":"1955-04-24"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z955","I129","N189","E039","E785","M109","I2510","N1832","E559","E8722","N2581","E790","H6592","J069","Z79899","R079","K219","R059","R110","R1011","K2100","N200","Z125","K644","E782","L989","E568"],"date":["2025-07-14","2026-05-11","2025-07-14","2026-01-12","2025-07-14","2025-10-22","2026-05-22","2026-05-22","2025-11-14","2025-11-14","2026-05-22","2025-11-14","2025-01-06","2025-03-26","2025-01-06","2025-01-13","2025-03-26","2025-04-28","2025-03-26","2025-03-26","2025-04-28","2025-05-23","2025-04-28","2025-04-28","2025-04-28","2026-01-12","2026-05-22"],"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":[["","","LOVASTATIN","40 MG","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","CARVEDILOL","6.25 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","DOXEPIN HYDROCHLORIDE","25 MG","","Select","Select",""],["","","ALLOPURINOL","100 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","137 MCG","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","30 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","ABRYSVO","120 MCG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","5 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","PRASUGREL HYDROCHLORIDE","10 MG","","Select","Select",""],["","","PROCTO-MED HC","2.50%","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Isosorb Mono Tab","30 MG","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Allopurinol Tab","100 MG","","Select","Select",""],["","","Doxepin Hcl Cap","25 MG","","Select","Select",""],["","","Procto-Med Cre Hc 2.5%","","","Select","Select",""],["","","Losartan\/Hct Tab 100-12.5","","","Select","Select",""],["","","Prasugrel Tab","10 MG","","Select","Select",""],["","","Levothyroxin Tab","137 MCG","","Select","Select",""],["","","Losartan Pot Tab","100 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Famotidine Tab","40 MG","","Select","Select",""],["","","Carvedilol Tab","6.25 MG","","Select","Select",""],["","","Zolpidem Tab","5 MG","","Select","Select",""],["","","Tamsulosin Cap","0.4 MG","","Select","Select",""],["","","Abrysvo Inj","120 MCG","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","Select","Select",""],["","","Lovastatin Tab","40 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":""}]}]}