{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEOLA STOKES","gend":1,"currentgend":"","add":"701 SE 36th St","city":"Topeka","state":"KS","zip":"66605","dob":"1948-10-13","age":"","mstatus":"","insh":"K44007256","cliId":"","pno":"7857833446","cno":"","email":"","ename":"","eno":"","pphy":"TANYA RUNNEBAUM","ppno":"7852670744","pcpadd":"2909 SE WALNUT DRIVE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66605-2189","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1073243713","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007256","medicareid":"2QT3MQ3EP14","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":["I10","N1831","E782","Z7901","I480","R52","E1122","Z79899","Z0000","Z23","N189","Z13820","R92323","Z803","H40023","H43812","Z961","H26492","H31092","R42","E119","Z87891","Z8739","Z1231","K449","E8342","R197","R944","R7401","R748","R82998","K2950","B9681","E1142","Z7984","I129","I2510","Z881"],"date":["2026-05-18","2026-06-03","2026-05-19","2026-05-18","2026-05-19","2025-09-29","2026-06-03","2025-10-30","2025-10-23","2025-10-23","2026-05-19","2025-02-05","2025-02-05","2025-02-05","2025-03-10","2025-03-10","2025-03-10","2026-03-11","2026-03-11","2025-05-01","2026-03-11","2026-06-15","2026-03-09","2026-04-23","2026-05-19","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-05-19","2026-05-19","2026-05-19","2026-05-19","2026-05-19","2026-05-19","2026-05-19"],"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":[["","","CONTOUR PLUS BLUE BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","MICROLET LANCETS","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","5 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","ENALAPRIL MALEATE","20 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","CONTOUR PLUS BLOOD GLUCOSE TEST STRIPS","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","METRONIDAZOLE","250 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","TETRACYCLINE HYDROCHLORIDE","500 MG","","Select","Select",""],["","","OMEPRAZOLE","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":""}]}]}