{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JO A HESSLER","gend":1,"currentgend":"","add":"8042 N 63rd St W","city":"Valley Center","state":"KS","zip":"67147","age":"","mstatus":"","insh":"K44008595","cliId":"","pno":"3162508311","cno":"","email":"jojocopperbender@gmail.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008595","medicareid":"9Y22G20WK09","medicaidid":"9Y22G20WK09","pcpFlag":"","dob":"1956-07-31"},{"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":["Z171","Z79899","R519","M546","S299XXA","S3992XA","R079","Z743","Z853","E063","Z7984","I5020","I4892","R0609","I495","I252","E119","E785","R42","Z7985","S51011A","I214","N179","I509","A419","I10","N3000","E1165","S40012A","M25552","Z7901","E782","E039"],"date":["2026-06-17","2026-03-20","2025-07-11","2025-07-11","2025-07-11","2025-07-11","2025-07-11","2025-07-11","2026-03-04","2026-03-04","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-03-20","2025-07-11","2025-04-24","2025-01-07","2026-03-20","2025-01-02","2026-03-20","2025-01-02","2025-01-01","2025-07-11","2025-07-11","2025-07-11","2026-03-20","2026-03-20"],"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":[["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","25 MCG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","51 MG","","Select","Select",""],["","","OZEMPIC","4 MG","","Select","Select",""],["","","JARDIANCE","10 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ONDANSETRON HYDROCHLORIDE","8 MG","","Select","Select",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","FARXIGA","10 MG","","Select","Select",""],["","","ENTRESTO","51 MG","","Select","Select",""],["","","AMIODARONE HYDROCHLORIDE","200 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","Farxiga Tab","10 MG","","Select","Select",""],["","","Entresto Tab 24-26Mg","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Ondansetron Tab","8 MG","","Select","Select",""],["","","Oxycod\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Jardiance Tab","10 MG","","Select","Select",""],["","","Entresto Tab 49-51Mg","","","Select","Select",""],["","","Sacub\/Valsar Tab 49-51Mg","","","Select","Select",""],["","","Metoprol Suc Tab","25 MG","","Select","Select",""],["","","Ozempic Inj","4 MG","","Select","Select",""],["","","Cefdinir Cap","300 MG","","Select","Select",""],["","","Cyclobenzapr Tab","10 MG","","Select","Select",""],["","","Levothyroxin Tab","25 MCG","","Select","Select",""],["","","Rosuvastatin Tab","10 MG","","Select","Select",""],["","","Lisinopril Tab","5 MG","","Select","Select",""],["","","Eliquis Tab","5 MG","","Select","Select",""],["","","Amiodarone Tab","200 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":""}]}]}