{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HERBERT C BATH","gend":0,"currentgend":"","add":"200 South Oak Ave","city":"Altamont","state":"KS","zip":"67330","age":"","mstatus":"","insh":"K44007344","cliId":"","pno":"6206059160","cno":"","email":"","ename":"","eno":"","pphy":"BENJAMIN COCHRAN","ppno":"6203322000","pcpadd":"607 E 4TH ST","pcpcity":"ALTAMONT","pcpstate":"KS","pcpzip":"67301-7301","pcpcounty":"","pcpid":"","pcpname":"LCMC PHYSICIANS GROUP","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1912339672","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007344","medicareid":"4PW0VP7CU11","medicaidid":"4PW0VP7CU11","pcpFlag":"","dob":"1942-08-09"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["Z794","R21","B369","D630","C7951","M8588","C20","E119","E7800","I10","D649","M1990","Z79818","C61","M47812","M2578","E782","R310"],"date":["2026-03-03","2025-06-27","2025-06-27","2025-12-02","2026-03-03","2025-09-16","2025-04-01","2025-06-24","2025-06-24","2026-03-03","2025-04-01","2025-04-01","2025-04-01","2026-06-03","2025-05-15","2025-05-15","2026-03-03","2026-06-03"],"priorHcc":["","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","DICLOFENAC SODIUM DR","50 MG","","Select","Select",""],["","","CLONIDINE HYDROCHLORIDE","0.1 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","GENTAMICIN SULFATE","0.30%","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","MOUNJARO","10 MG","","Select","Select",""],["","","UNIFINE PENTIPS 32GX4MM","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE PHOSPHATE","60 MG","","Select","Select",""],["","","KETOCONAZOLE","2%","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","","","Select","Select",""],["","","ERLEADA","240 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000 MG","","Select","Select",""],["","","Diclofenac Tab","50 MG","","Select","Select",""],["","","Clonidine Tab","0.1 MG","","Select","Select",""],["","","Mounjaro Inj 12.5\/0.5","","","Select","Select",""],["","","Unfine Pntp Mis 32Gx4Mm","","","Select","Select",""],["","","Unifine Pntp Mis 32Gx4Mm","","","Select","Select",""],["","","Erleada Tab","240 MG","","Select","Select",""],["","","Lantus Solos Inj 100\/Ml","","","Select","Select",""],["","","Ketoconazole Cre 2%","","","Select","Select",""],["","","Mounjaro Inj 7.5\/0.5","","","Select","Select",""],["","","Metformin Tab","1000 MG","","Select","Select",""],["","","Mounjaro Inj","10 MG","","Select","Select",""],["","","Gentamicin Sol 0.3% Op","","","Select","Select",""],["","","Metformn Osm Tab 1000 Er","","","Select","Select",""],["","","Amlodipine Tab","10 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":""}]}]}