{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALLEN A HEMBERGER","gend":0,"currentgend":"","add":"202 N 7th St","city":"CONWAY SPRINGS","state":"KS","zip":"67031","age":"","mstatus":"","insh":"K44009213","cliId":"","pno":"3167061192","cno":"","email":"aahemberger@havilandtelco.com","ename":"","eno":"","pphy":"NIZAR KIBAR","ppno":"6209141200","pcpadd":"401 E 1ST STREET","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67003-2526","pcpcounty":"","pcpid":"","pcpname":"PATTERSON HEATLH CLINIC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO Box 414","madd2":"","madd3":"","mcity":"CONWAY SPRINGS","mstate":"KS","mzip":"67031","pcpfaxno":"6204911250","pcpnpi":"1124096300","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009213","medicareid":"5UR1MP9XC03","medicaidid":"5UR1MP9XC03","pcpFlag":"","dob":"1950-11-07"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E039","N1832","R001","R42","I77819","E782","E119","R0609","Z87891","E113392","H35372","H43821","H3563","D3131","H10403","H179","H16223","H01009","H25813","E1140","N138","N4289","E785","E113312","H43812","C61","E11319"],"date":["2026-02-03","2026-02-03","2026-02-03","2025-10-17","2025-10-17","2025-10-17","2026-02-03","2025-10-17","2025-10-17","2025-10-17","2026-05-27","2025-12-15","2025-12-15","2025-12-15","2026-01-14","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2025-01-30","2026-02-05","2025-11-21","2025-01-30","2026-01-14","2026-01-14","2026-02-03","2026-02-03"],"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":[["","","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","FARXIGA","10 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","137 MCG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","XDEMVY","0.25%","","Select","Select",""],["","","Farxiga Tab","10 MG","","Select","Select",""],["","","Xdemvy Dro 0.25%","","","Select","Select",""],["","","Losartan\/Hct Tab 100-12.5","","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Levothyroxin Tab","137 MCG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Amlodipine Tab","5 MG","","Select","Select",""],["","","Tamsulosin Cap","0.4 MG","","Select","Select",""],["","","Spironolact Tab","25 MG","","Select","Select",""],["","","Atorvastatin Tab","40 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":""}]}]}