{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIE B MELLE","gend":1,"currentgend":"","add":"601 S Pennsylvania Ave","city":"Independence","state":"KS","zip":"67301","dob":"1960-04-01","age":"","mstatus":"","insh":"K44008774","cliId":"","pno":"6209260449","cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"Apt 203","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008774","medicareid":"3RA4AM8GK67","medicaidid":"3RA4AM8GK67","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H43813","H43391","H353131","E785","I10","I639","E1140","R945","F329","Z794","Z79899","Z8673"],"date":["2025-12-11","2025-12-11","2025-12-11","2026-04-15","2026-04-15","2025-07-30","2025-07-30","2026-04-15","2026-04-15","2025-05-07","2025-05-07","2026-04-15"],"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":[["","","EMBECTA PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"","","","Select","Select",""],["","","GABAPENTIN","600 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDRALAZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","80 MG","","Select","Select",""],["","","MONTELUKAST SODIUM","10 MG","","Select","Select",""],["","","NOVOLIN 70\/30 FLEXPEN","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","MOUNJARO","10 MG","","Select","Select",""],["","","ENALAPRIL MALEATE","20 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","20 MG","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","Embecta Nano Mis 32Gx4Mm","","","Select","Select",""],["","","Enalapril Tab","20 MG","","Select","Select",""],["","","Montelukast Tab","10 MG","","Select","Select",""],["","","Furosemide Tab","20 MG","","Select","Select",""],["","","Mounjaro Inj","5 MG","","Select","Select",""],["","","Novolin Inj 70\/30 Fp","","","Select","Select",""],["","","Lantus Solos Inj 100\/Ml","","","Select","Select",""],["","","Hydralazine Tab","25 MG","","Select","Select",""],["","","Mounjaro Inj 2.5\/0.5","","","Select","Select",""],["","","Mounjaro Inj 7.5\/0.5","","","Select","Select",""],["","","Gabapentin Tab","600 MG","","Select","Select",""],["","","Pot Chloride Tab","10 MEQ","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Atorvastatin Tab","80 MG","","Select","Select",""],["","","Escitalopram Tab","20 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","Select","Select",""],["","","Amlodipine 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":""}]}]}