{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA P JACOBS","gend":1,"currentgend":"","add":"2324 SW Edgewater Ter","city":"Topeka","state":"KS","zip":"66614","age":"","mstatus":"","insh":"K44007899","cliId":"","pno":"7852893014","cno":"","email":"jacobs.aj21@gmail.com","ename":"","eno":"","pphy":"SUSAN SWORDS","ppno":"7852331747","pcpadd":"4505 NW FIELDING RD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1696","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":"1679972731","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007899","medicareid":"4YV7WP9WT49","medicaidid":"","pcpFlag":"","dob":"1947-11-26"},{"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":["R55","I10","I480","E039","Z950","E8351","N2581","E559","R7309","N950","Z7983","Z79890","Z780","Z87311","E0590","Z13820","Z0000","J4520","H6123","R768","I442","J45909","R0902","R92333","J4521","H04123","H26493","H5211","R7981","R634","J479","J4540","Q2547","R1013","M810","R7689","K222","K449","S0990XA","S51811A","S0511XA","S61511A","R220","R000","R944","R791","W010XXA","Y929","Z043","M47812","S0993XA","M47814","M47816","R739","M25531","S61511D","W19XXXD","E785","Z7951"],"date":["2026-03-25","2026-02-12","2026-03-25","2026-02-12","2026-02-12","2025-11-06","2025-10-06","2025-11-06","2026-03-25","2025-09-19","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-09-04","2025-09-04","2025-09-04","2025-08-29","2026-05-07","2026-02-12","2026-01-12","2025-12-09","2025-02-03","2025-02-13","2025-02-13","2025-02-13","2025-06-11","2026-01-14","2026-01-12","2026-01-12","2026-01-12","2026-01-14","2026-02-10","2026-02-12","2026-02-12","2026-04-01","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-04-01","2026-04-01","2026-04-01","2026-04-01","2026-02-12","2026-02-12"],"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":[["","","RISEDRONATE SODIUM","35 MG","","Select","Select",""],["","","LEVETIRACETAM","500 MG","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","88 MCG","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE\/SALMETEROL DISKUS","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","AZITHROMYCIN","250 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":""}]}]}