{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH E MARTIN","gend":0,"currentgend":"","add":"724 E 1700TH RD","city":"BALDWIN CITY","state":"KS","zip":"66006","age":"","mstatus":"","insh":"K44009025","cliId":"","pno":"7855943305","cno":"","email":"","ename":"","eno":"","pphy":"JENNIFER SCHWEDA","ppno":"7855055475","pcpadd":"406 AMES ST","pcpcity":"BALDWIN CITY","pcpstate":"KS","pcpzip":"66046-5238","pcpcounty":"","pcpid":"","pcpname":"LMH HEALTH PRIMARY CARE-BALDWIN CITY","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"321 CRIMSON AVE","madd2":"","madd3":"","mcity":"BALDWIN CITY","mstate":"KS","mzip":"660064157","pcpfaxno":"7855055270","pcpnpi":"1457680647","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009025","medicareid":"5J52M64RQ06","medicaidid":"5J52M64RQ06","pcpFlag":"","dob":"1932-09-02"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z85828","L570","Z1283","D485","L821","L814","I4891","I495","I4720","I872","G629","E119","R4189","I4820","Z7689","Z7901","H353121","I480","R4182","F0390","L905","H40003","H5213","I255","R32","R21","Z79899","I5020","R062","R0609","B372","I509","L304","R300","R451","G309","E1142","I110","I5022","I2510","E785","Z888","Z950","Z951","Z8673","E1151","E1136","S61412D","S51811D","N401","N138","R351","I10","H9190","E663","H3530","Z556","Z6830","E782","Z23","R5383","I5032","I444","I4589","R9431","T50904A","I493","B356","Z1331","R7303","Z87438","I4821","R413","Z0000","H9193","L720"],"date":["2026-05-04","2025-12-29","2025-07-16","2025-07-16","2026-05-04","2025-07-16","2026-01-27","2026-04-14","2026-04-14","2025-12-29","2025-07-28","2025-10-29","2025-07-28","2025-12-29","2026-02-18","2026-02-18","2025-10-29","2026-04-14","2025-11-09","2025-11-09","2025-02-05","2025-02-13","2025-02-13","2025-12-29","2025-02-28","2025-02-28","2026-02-18","2025-03-14","2025-03-26","2025-03-26","2025-05-14","2026-05-14","2025-05-14","2025-05-14","2025-11-07","2025-11-09","2025-12-29","2025-11-09","2025-11-09","2026-02-18","2025-12-29","2025-11-09","2026-02-18","2026-02-18","2025-12-29","2025-12-29","2025-12-29","2025-12-04","2025-12-04","2026-05-14","2025-12-29","2025-12-29","2026-05-04","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-12-29","2025-02-28","2026-01-16","2026-01-16","2026-02-18","2026-02-18","2026-02-18","2026-02-18","2026-01-27","2026-04-14","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-14","2026-05-14","2026-05-14","2026-05-14"],"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":[["","","XARELTO","20 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CLOTRIMAZOLE","1%","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","5 MG","","Select","Select",""],["","","AMOXICILLIN","875 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","25 MG","","Select","Select",""],["","","CARVEDILOL","12.5 MG","","Select","Select",""],["","","MEMANTINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","FLUCONAZOLE","200 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","0.08%","","Select","Select",""],["","","NEOMYCIN\/POLYMYXIN\/HC","1%","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","500 MG","","Select","Select",""],["","","KETOCONAZOLE","2%","","Select","Select",""],["","","HYDROCORTISONE","2.50%","","Select","Select",""],["","","Xarelto Tab","20 MG","","Select","Select",""],["","","Clotrimazole Cre 1%","","","Select","Select",""],["","","Fluad Inj 2025-26","","","Select","Select",""],["","","Ciprofloxacn Tab","500 MG","","Select","Select",""],["","","Nystatin Pow 100000","","","Select","Select",""],["","","Ipratropium\/ Sol Albuter","","","Select","Select",""],["","","Furosemide Tab","20 MG","","Select","Select",""],["","","Pot Cl Micro Tab","10 MEQ","","Select","Select",""],["","","Penicilln Vk Tab","500 MG","","Select","Select",""],["","","Carvedilol Tab","12.5 MG","","Select","Select",""],["","","Fluconazole Tab","200 MG","","Select","Select",""],["","","Ketoconazole Cre 2%","","","Select","Select",""],["","","Amoxicillin Tab","875 MG","","Select","Select",""],["","","Rosuvastatin Tab","5 MG","","Select","Select",""],["","","Memantine Tab","10 MG","","Select","Select",""],["","","Memantine Tab Hcl","10 MG","","Select","Select",""],["","","Hydrocort Cre 2.5%","","","Select","Select",""],["","","Tamsulosin Cap","0.4 MG","","Select","Select",""],["","","Losartan Pot Tab","25 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":""}]}]}