{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOE H SCRIBNER","gend":0,"currentgend":"","add":"529 ARIZONA ST","city":"LAWRENCE","state":"KS","zip":"66049","dob":"1940-07-10","age":"","mstatus":"","insh":"K44007536","cliId":"","pno":"7805100705","cno":"","email":"","ename":"","eno":"","pphy":"APRIL SPRAGUE","ppno":"7858433750","pcpadd":"2415 MASSACHUSETTS ST","pcpcity":"LAWRENCE","pcpstate":"KS","pcpzip":"66046-4827","pcpcounty":"","pcpid":"","pcpname":"LMH HEALTH PRIMARY CARE - FREE STATE","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4000 W 6TH ST STE B","madd2":"PMB 147","madd3":"","mcity":"LAWRENCE","mstate":"KS","mzip":"66049","pcpfaxno":"","pcpnpi":"1619693074","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007536","medicareid":"1J90G27NH34","medicaidid":"1J90G27NH34","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z85828","Z1283","L570","D485","L821","L814","N528","R208","Z79899","R718","E785","Z7689","R9720","N401","I10","R748","Z98890","E7800","D1722","D696","R0789","Z8042","N451","K5900","J302","R1024","R1031","N4340","R7309"],"date":["2025-06-24","2025-06-24","2025-06-24","2025-06-24","2025-06-24","2025-06-24","2025-06-10","2025-06-10","2026-04-28","2025-06-10","2025-10-22","2026-01-26","2026-04-21","2026-04-28","2025-10-22","2026-04-21","2025-10-22","2025-01-07","2025-01-07","2026-04-28","2025-04-10","2025-03-19","2026-01-28","2026-01-28","2026-04-28","2026-01-28","2026-01-26","2026-01-28","2026-04-21"],"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":[["","","LISINOPRIL","5 MG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","20 MG","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","CLOTRIMAZOLE","1%","","Select","Select",""],["","","Comirnaty Inj 30\/.3Ml","","","Select","Select",""],["","","Clotrimazole Cre 1%","","","Select","Select",""],["","","Fluad Inj 2025-26","","","Select","Select",""],["","","Fluconazole Tab","150 MG","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Pantoprazole Tab","20 MG","","Select","Select",""],["","","Lisinopril Tab","5 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":""}]}]}