{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAKE C LEWIS","gend":0,"currentgend":"","add":"5773 CR 5000","city":"Cherryvale","state":"KS","zip":"67335","age":"","mstatus":"","insh":"K44008541","cliId":"","pno":"6209882831","cno":"","email":"","ename":"","eno":"","pphy":"LORI ISLE","ppno":"6208205800","pcpadd":"1902 S HWY 59  BLDG E","pcpcity":"PARSONS","pcpstate":"KS","pcpzip":"67357-4948","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":"1568929172","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008541","medicareid":"6T21X73AE24","medicaidid":"6T21X73AE24","pcpFlag":"","dob":"1946-07-25"},{"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":["I340","I700","D649","I2510","I10","E785","E119","G4733","Z79899","Z7901","Z955","D500","L989","Z1331","K922","B351","L600","E1142","Z006","E1129","R809","I4821","R600","Z0130","I872","E782","E1140","Z85038","I4891","H35361","H43812","H02831","H02834","Z7984","G629","E11610","K633","Z7902","Z9049","Z87442","M79674","E538","Z794"],"date":["2025-06-13","2025-06-13","2025-07-21","2025-07-21","2026-04-30","2026-04-30","2026-01-14","2026-01-14","2025-06-13","2025-06-13","2026-01-14","2026-04-30","2025-06-25","2026-02-13","2025-09-09","2025-07-14","2026-01-12","2026-04-30","2025-05-01","2025-07-21","2025-07-21","2026-01-14","2025-07-21","2026-01-14","2025-08-29","2025-01-16","2025-01-16","2025-06-13","2025-03-03","2025-03-26","2025-03-26","2025-03-26","2025-03-26","2025-05-01","2025-04-17","2026-04-30","2025-03-04","2025-03-04","2025-05-01","2025-05-01","2026-04-13","2026-04-30","2026-04-30"],"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":[["","","SODIUM SULFATE\/POTASSIUM SULFATE\/MAGNESIUM SULFATE","","","Select","Select",""],["","","DABIGATRAN ETEXILATE","150 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","BD PEN NEEDLE\/SHORT\/ULTRA-FINE\/31G X 8MM","","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","SUCRALFATE","1 GM","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","Sucralfate Tab","1 GM","","Select","Select",""],["","","Comirnaty Inj 30\/.3Ml","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Furosemide Tab","20 MG","","Select","Select",""],["","","Triamcinolon Oin 0.1%","","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Bd Pen Needl Mis 31Gx8Mm","","","Select","Select",""],["","","Sodium\/Potas Sol Magnesiu","","","Select","Select",""],["","","Lantus Solos Inj 100\/Ml","","","Select","Select",""],["","","Lisinopril Tab","10 MG","","Select","Select",""],["","","Metoprol Suc Tab","25 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Dabigatran Cap","150 MG","","Select","Select",""],["","","Simvastatin Tab","20 MG","","Select","Select",""],["","","Eliquis 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":""}]}]}