{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOLORES S ESQUIVEL DOME","gend":1,"currentgend":"","add":"6006  Republic  Rd","city":"Oskaloosa","state":"KS","zip":"66066","dob":"1947-09-15","age":"","mstatus":"","insh":"K44008787","cliId":"","pno":"7852204092","cno":"","email":"WHOBOOP@GMAIL.COM","ename":"","eno":"","pphy":"JENNIFER STRICKLAND","ppno":"7855055475","pcpadd":"3211 S IOWA ST","pcpcity":"LAWRENCE","pcpstate":"KS","pcpzip":"66046-5238","pcpcounty":"","pcpid":"","pcpname":"LMH HEALTH PRIMARY CARE","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"6006  Republic  Rd","madd2":"","madd3":"","mcity":"Oskaloosa","mstate":"KS","mzip":"66066","pcpfaxno":"7855055326","pcpnpi":"1831467729","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008787","medicareid":"2P62MF5QK22","medicaidid":"2P62MF5QK22","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":["R09A2","R053","Z7689","I110","I5030","E782","E039","M8580","R410","I5032","G4730","I739","Z720","Z79899","Z8249","R079","Z7984","R300","N390","R399","R519","M79644","Z98890","M25512","M25511","E119","I2510","E7800","R928","M25561","E785","G4762","M19019","E663","I10","E538","L309","M79671","F10929","R0602","E876","V877XXA","Y92410","S0990XA","S199XXA","M47812","S3991XA","S299XXA"],"date":["2025-07-30","2025-07-30","2026-03-26","2025-09-15","2025-09-15","2025-09-15","2026-03-03","2026-01-27","2026-01-27","2025-09-15","2025-09-15","2026-01-27","2026-04-08","2025-09-15","2025-09-15","2026-05-06","2025-08-28","2025-12-10","2025-12-10","2025-01-02","2025-01-02","2025-01-27","2025-01-27","2025-03-31","2025-03-31","2026-01-27","2025-09-15","2026-03-03","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-03-03","2026-03-03","2026-03-26","2026-04-08","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-05-06"],"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":[["","","TRAZODONE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","EZETIMIBE","10 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","IRBESARTAN","150 MG","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","100 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","25 MCG","","Select","Select",""],["","","REPATHA SURECLICK","140 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100 MG","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE","100 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","Paxlovid Tab 300-100","","","Select","Select",""],["","","Smz\/Tmp Ds Tab 800-160","","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Triamcinolon Cre 0.1%","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Ezetimibe Tab","10 MG","","Select","Select",""],["","","Metoprol Suc Tab","100 MG","","Select","Select",""],["","","Repatha Sure Inj","140 MG","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Levothyroxin Tab","25 MCG","","Select","Select",""],["","","Trazodone Tab","50 MG","","Select","Select",""],["","","Nitrofurantn Cap","100 MG","","Select","Select",""],["","","Mnexspike Inj 2025-26","","","Select","Select",""],["","","Irbesartan Tab","150 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":""}]}]}