{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARLEN D FRANK","gend":0,"currentgend":"","add":"820 CHILTON AVE","city":"WELLSVILLE","state":"KS","zip":"660928846","age":"","mstatus":"","insh":"K44009252","cliId":"","pno":"7868931629","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":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"7855055270","pcpnpi":"1457680647","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009252","medicareid":"7WU1D89FX92","medicaidid":"7WU1D89FX92","pcpFlag":"","dob":"1940-07-25"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["S62660B","Z7689","Z7901","H04123","H18513","H40053","H33311","H5111","H5022","H02831","H02834","G629","Z95818","I480","Z8673","I498","I452","R0989","I3481","I350","I340","I517","K5190","K219","I69398","R2689","R339","I495","E039","Z98890","I4819","Z4509","M7918","M7631","I2510","M7632","R4189","M1711","R42","R7301","Z86718","R5383","R350","R351","E785","Z87438","F419","R0683","G4710","M25561","Z950","Z79899","Z79890","K5730","Z23","I493","E7849","F5104","Z125"],"date":["2025-06-07","2026-05-28","2026-05-12","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-10-02","2025-12-20","2026-05-12","2026-03-27","2025-10-20","2025-10-20","2025-10-20","2025-12-19","2025-12-19","2025-12-19","2025-12-19","2026-05-12","2025-12-20","2025-12-19","2025-12-19","2025-12-20","2026-04-06","2026-05-12","2026-04-06","2025-12-19","2025-12-19","2025-01-16","2025-01-16","2025-05-19","2025-02-05","2026-05-12","2025-04-24","2025-03-31","2025-05-12","2025-05-12","2025-05-19","2026-05-12","2025-05-19","2025-12-20","2026-05-12","2025-05-19","2025-08-13","2025-08-13","2025-10-02","2026-05-12","2026-03-27","2025-12-20","2025-02-17","2025-06-07","2026-04-06","2026-05-12","2026-05-12","2026-05-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","200 MCG","","Select","Select",""],["","","MINOCYCLINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","SULFASALAZINE","500 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","WARFARIN SODIUM","5 MG","","Select","Select",""],["","","AMIODARONE HYDROCHLORIDE","200 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","5 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","DONEPEZIL HYDROCHLORIDE","5 MG","","Select","Select",""],["","","CARVEDILOL","6.25 MG","","Select","Select",""],["","","DIGOXIN","0.125 MG","","Select","Select",""],["","","DILTIAZEM HYDROCHLORIDE ER","120 MG","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Sulfasalazin Tab","500 MG","","Select","Select",""],["","","Fluad Inj 2025-26","","","Select","Select",""],["","","Levothyroxin Tab","200 MCG","","Select","Select",""],["","","Donepezil Tab","5 MG","","Select","Select",""],["","","Diltiazem Cap","120 MG","","Select","Select",""],["","","Minocycline Cap","100 MG","","Select","Select",""],["","","Warfarin Tab","5 MG","","Select","Select",""],["","","Digoxin Tab","0.125 MG","","Select","Select",""],["","","Carvedilol Tab","6.25 MG","","Select","Select",""],["","","Zolpidem Tab","5 MG","","Select","Select",""],["","","Atorvastatin Tab","20 MG","","Select","Select",""],["","","Omeprazole Cap","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":""}]}]}