{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DUANE E SEARS","gend":0,"currentgend":"","add":"403 N A ST","city":"WELLINGTON","state":"KS","zip":"67152","dob":"1930-01-02","age":"","mstatus":"","insh":"K44009160","cliId":"","pno":"6202227220","cno":"","email":"doris.lawrence@ymail.com","ename":"","eno":"","pphy":"STEPHEN HAWKS","ppno":6203267451,"pcpadd":"507 E 16TH ST","pcpcity":"WELLINGTON","pcpstate":"KS","pcpzip":"67152-4350","pcpcounty":"","pcpid":"","pcpname":"ADVANCED ORTHOPAEDIC ASSOC PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5384 182nd Rd","madd2":"","madd3":"","mcity":"Winfield","mstate":"KS","mzip":"67156","pcpfaxno":"3166311617","pcpnpi":"1144057548","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009160","medicareid":"2C13W38VP71","medicaidid":"2C13W38VP71","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":["R338","Z8551","I480","E038","Z711","C61","R600","R8271","D090","K4090","L03312","D649","R5383","Z8546","E7800","I4891","Z1329","Z7982","Z9079","Z960","W010XXA","S42212A","R54","S199XXA","S0990XA","R519","S6992XA","M546","S299XXA","S3992XA","S42202A","S42352A","W1839XA","J9601","E8720","E8342","Z9981","S42302A","K219","R609","I2510","N139","E8351","S22009A","C679","Z978","N390","T83091A","L02212","S22080A","M79602","M549","K5900","G4700","I10","S42302D","T83511A","S22001D","Z741","M6281","R2689","M6289","Z7409","R41841"],"date":["2026-05-20","2026-06-09","2026-01-29","2025-09-02","2025-09-02","2026-04-20","2025-09-10","2026-04-20","2025-10-15","2025-10-28","2025-12-26","2025-03-21","2025-03-21","2026-06-09","2025-03-21","2026-01-29","2025-03-21","2026-06-09","2026-05-07","2026-03-31","2026-01-25","2026-01-25","2026-01-29","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-29","2026-01-29","2026-01-29","2026-01-29","2026-01-29","2026-01-29","2026-02-05","2026-02-25","2026-03-05","2026-03-05","2026-02-25","2026-02-25","2026-01-29","2026-01-29","2026-01-29","2026-03-05","2026-01-19","2026-01-19","2026-01-23","2026-03-05","2026-03-05","2026-03-05","2026-03-05","2026-03-23","2026-03-31","2026-01-19","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25"],"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":[["","","PANTOPRAZOLE SODIUM","20 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","AREXVY","120 MCG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","Arexvy Inj","120 MCG","","Select","Select",""],["","","Smz\/Tmp Ds Tab 800-160","","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Ciprofloxacn Tab","500 MG","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Furosemide Tab","20 MG","","Select","Select",""],["","","Pot Chloride Tab","10 MEQ","","Select","Select",""],["","","Pantoprazole Tab","20 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":""}]}]}