{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JIM O COVEY","gend":0,"currentgend":"","add":"1309 E 165th St","city":"Fort Scott","state":"KS","zip":"66701","age":"","mstatus":"","insh":"K44008732","cliId":"","pno":"6202239423","cno":"","email":"Destinyallenom@yahoo.com","ename":"","eno":"","pphy":"GREGORY KING","ppno":"6202238064","pcpadd":"401 WOODLAND HILLS BLVD","pcpcity":"FORT SCOTT","pcpstate":"KS","pcpzip":"66701-8797","pcpcounty":"","pcpid":"","pcpname":"FREEMAN OAK HILL HEALTH SYSTEM","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1255423364","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008732","medicareid":"8NA9VU2JV15","medicaidid":"8NA9VU2JV15","pcpFlag":"","dob":"1948-02-05"},{"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":["I081","I10","I6523","I493","K589","R197","K8020","M1711","N3281","R319","R361","K2100","K2970","K449","K5730","K641","K644","R609","M47816","M47817","M48061","M51369","M51379","M51362","I340","I7789","R350","N400","N410","L239","R140","K2950","M1712","H9313","J302","J3489","D1801","D485","M23261","M2241","M25461","H6982","C44329","K219","M8580","R079","I2510","Z8249","Z87891"],"date":["2025-05-28","2026-05-14","2025-05-23","2026-05-14","2025-12-02","2025-12-15","2025-12-10","2026-06-02","2025-11-05","2025-11-05","2025-11-05","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2025-01-24","2025-01-24","2025-01-24","2025-01-24","2025-01-24","2025-01-24","2025-01-27","2025-05-23","2025-05-23","2025-10-13","2026-06-02","2025-11-10","2025-11-10","2025-12-10","2025-12-15","2026-02-11","2026-02-26","2026-02-26","2026-02-26","2026-04-27","2026-04-27","2026-05-17","2026-05-17","2026-05-17","2026-01-27","2026-06-02","2026-06-02","2026-06-02","2026-05-14","2026-05-14","2026-05-14","2026-05-14"],"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":[["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","TRIAMTERENE\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","DICYCLOMINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","XIFAXAN","550 MG","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Ciprofloxacn Tab","500 MG","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Xifaxan Tab","550 MG","","Select","Select",""],["","","Triamt\/Hctz Cap 37.5-25","","","Select","Select",""],["","","Hydroco\/Apap Tab 7.5-325","","","Select","Select",""],["","","Metoprol Suc Tab","50 MG","","Select","Select",""],["","","Dicyclomine Cap","10 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Cefdinir Cap","300 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":""}]}]}