{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH M ROOT","gend":1,"currentgend":"","add":"5121 Congressional Cir","city":"Lawrence","state":"KS","zip":"66049","dob":"1955-12-27","age":"","mstatus":"","insh":"K44008162","cliId":"","pno":"9132064733","cno":"9132064733","email":"dec271955dr@gmail.com","ename":"","eno":"","pphy":"AMBER CHITWOOD","ppno":"7853714921","pcpadd":"1811 WAKARUSA DR","pcpcity":"LAWRENCE","pcpstate":"KS","pcpzip":"66047-2082","pcpcounty":"","pcpid":"","pcpname":"PRIME TMS","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"Apt E107","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"8889655147","pcpnpi":"1558018184","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008162","medicareid":"8TD4FJ1CT95","medicaidid":"8TD4FJ1CT95","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96651","R2689","R531","M5459","M4003","M4047","M79672","M79671","M48062","Z7901","Z7689","N816","N819","M25562","F419","F900","I480","Z79899","M8700","R443","F1010","W1839XA","S0990XA","S299XXA","F22","F988","F32A","Y909","R441","X58XXXA","F1020","M4854XA","F10239","M62838","E785","F909","G2581","G8929","W19XXXA","M542","R519","H547","Z634","R4589","F331","Z961","M1712","M87852","S83242A","M25462","M7122","M21862","K5909","H9313","H26491","H401133","H35373","H04123","H52223","M810","M47816","M25552","M79652","M6258","R413","M4312","S22040S","S22080S","M47814","S32040S"],"date":["2025-04-29","2025-04-29","2025-04-29","2025-04-29","2025-04-29","2025-04-29","2025-04-29","2025-04-29","2026-05-14","2026-05-14","2026-06-03","2025-08-18","2025-08-18","2025-08-12","2026-05-11","2026-05-11","2026-04-01","2025-11-04","2026-04-01","2025-11-03","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-10-24","2025-10-24","2025-10-27","2025-10-27","2025-10-24","2025-10-24","2026-04-01","2025-10-27","2025-10-24","2025-10-24","2025-10-27","2025-10-24","2025-10-27","2025-10-27","2025-11-18","2026-05-14","2025-11-18","2025-10-27","2025-10-27","2025-10-24","2026-04-01","2025-04-25","2026-05-14","2025-07-22","2025-07-22","2025-11-04","2025-11-04","2025-11-04","2025-05-01","2026-01-27","2026-01-16","2026-05-15","2026-02-03","2026-02-03","2026-02-03","2026-04-01","2026-04-30","2026-06-04","2026-06-04","2026-06-04","2026-06-03","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30"],"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":[["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","DORZOLAMIDE HCL\/TIMOLOL MALEATE","","","Select","Select",""],["","","LATANOPROST","0.01%","","Select","Select",""],["","","XARELTO","20 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","50 MG","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","Select","Select",""],["","","TIZANIDINE HCL","2 MG","","Select","Select",""],["","","CLONAZEPAM","1 MG","","Select","Select",""],["","","AMPHETAMINE\/DEXTROAMPHETAMINE","20 MG","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","0.50%","","Select","Select",""],["","","VILAZODONE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","DESVENLAFAXINE ER","100 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","ESTRADIOL","0.01%","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","Desvenlafax Tab","100 MG","","Select","Select",""],["","","Xarelto Tab","20 MG","","Select","Select",""],["","","Clonazepam Tab","0.5 MG","","Select","Select",""],["","","Estradiol Cre 0.01%","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Prednisolone Sus 1% Op","","","Select","Select",""],["","","Latanoprost Sol 0.005%","","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Tizanidine Tab","2 MG","","Select","Select",""],["","","Metoprol Tar Tab","50 MG","","Select","Select",""],["","","Boostrix Inj","","","Select","Select",""],["","","Dorzol\/Timol Sol 2-0.5%Op","","","Select","Select",""],["","","Mnexspike Inj 2025-26","","","Select","Select",""],["","","Amphet\/Dextr Tab","20 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":""}]}]}