{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERWIN M CAMPBELL","gend":0,"currentgend":"","add":"1501 INVERNESS DR","city":"LAWRENCE","state":"KS","zip":"660472062","age":"","mstatus":"","insh":"K44008441","cliId":"","pno":"8476508446","cno":"","email":"ecampbell6950@sbcglobal.net","ename":"","eno":"","pphy":"ASHLEY LAUER","ppno":"7855055623","pcpadd":"1130 W 4TH ST","pcpcity":"LAWRENCE","pcpstate":"KS","pcpzip":"66044","pcpcounty":"","pcpid":"","pcpname":"LMH HEALTH HEART CENTER","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT 227","add3":"","madd1":"1501 INVERNESS DR","madd2":"APT 227","madd3":"","mcity":"LAWRENCE","mstate":"KS","mzip":"660472062","pcpfaxno":"","pcpnpi":"1619508736","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008441","medicareid":"4JY4UK7EM07","medicaidid":"4JY4UK7EM07","pcpFlag":"","dob":"1931-06-19"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B351","L603","Z7689","I4891","I5022","E785","D649","R768","K921","Z7901","Z9229","K259","K635","R2681","R7982","H353132","Z961","H40003","I484","R7689","I495","I2510","I4892","I2582","Z950","I4821","I083","Z951","R9431","D509","K5900","K828","K7402","Z860101","Z87898","Z8711","R195","K7400","R748","Z8674","R7401","R2689","D123","K3189","K648","K319","H35052","H43813","I255","D126","K7581","K8020","M353","Z7982","Z79899","Z87891","R262","M47816","L853","R531","R0989"],"date":["2026-04-18","2026-04-18","2026-03-02","2025-07-22","2025-07-22","2026-02-13","2025-07-22","2025-07-22","2025-07-30","2026-02-13","2025-07-30","2025-07-30","2025-07-30","2026-02-18","2025-08-05","2025-10-08","2025-10-08","2025-10-08","2025-10-15","2026-03-02","2025-12-12","2026-02-13","2026-04-17","2025-12-12","2026-02-13","2025-12-12","2025-12-12","2026-02-13","2025-12-12","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-03-05","2026-06-09","2025-06-04","2025-05-12","2025-05-06","2025-02-05","2025-02-21","2025-02-21","2025-02-21","2025-02-21","2025-05-14","2025-05-14","2026-02-13","2025-06-04","2025-06-04","2025-12-11","2025-12-11","2026-02-13","2026-06-09","2025-02-21","2026-02-13","2026-03-02","2026-04-18","2026-02-18","2026-02-18"],"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":[["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","Fluad Inj 2025-26","","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Omeprazole Cap","40 MG","","Select","Select",""],["","","Mnexspike Inj 2025-26","","","Select","Select",""],["","","Prednisone 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":""}]}]}