{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD E KAUP","gend":0,"currentgend":"","add":"1111 SW Belmont Lane","city":"Topeka","state":"KS","zip":"66604","dob":"1948-01-02","age":"","mstatus":"","insh":"K44009444","cliId":"","pno":"3039160223","cno":"","email":"","ename":"","eno":"","pphy":"LORA UTECH","ppno":"9135881227","pcpadd":"2200 SW 6TH AVE","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66217-9414","pcpcounty":"","pcpid":"","pcpname":"KANSAS MEDICAL CLINIC PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1111 SW Belmont Lane","madd2":"","madd3":"","mcity":"Topeka","mstate":"KS","mzip":"66604","pcpfaxno":"","pcpnpi":"1831205533","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009444","medicareid":"1RY4HY8QV64","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z86711","Z7901","K219","R1312","K269","K3189","K5909","I10","Z87442","D485","L821","R5383","E875","Z86718","G608","L218","M47817","M5450","G8929","E559","R1310","G629","M4856XA","M816","I7143","E871","Z862","N3943","M25552","E291","Z0001","Z1331","Z1389","M546","G609","D472","G3184","Z08","R202","M48061","M5126","M47814","E7800","I493","R931","N3281","G250","H31001","H43391","H5213","H52223","K2970","T182XXA","Z1211","Z800","Z860100","K5730","I2510","H903","G4733","H2512","H18593","K2950","K2100","R600","I491","Z5181","Z79899","M4807","D1801","Z872","Z85820","L814","R531","R293","R198","Z7409","I2699","I82409","M810","I341","R6889","E162","G20C","K2980","K225","R251","R351","N401","R3912","J302","R4189","L820","L118","R0609","E663","I7140","Z85828","I781"],"date":["2025-12-23","2026-02-16","2026-01-06","2026-01-06","2025-06-27","2026-01-06","2026-01-06","2026-05-04","2025-06-25","2026-06-18","2026-06-18","2025-06-25","2025-09-19","2025-07-09","2026-03-10","2025-12-18","2025-08-20","2025-11-03","2025-10-20","2026-05-19","2026-05-19","2026-03-03","2025-09-19","2025-09-19","2025-09-19","2025-09-19","2025-09-19","2025-11-03","2025-11-11","2026-05-04","2025-11-03","2025-11-03","2025-11-03","2025-11-14","2025-12-03","2026-03-03","2025-12-03","2026-03-09","2026-03-09","2025-12-16","2025-12-16","2025-12-16","2026-02-16","2026-02-16","2026-02-16","2025-08-01","2025-05-07","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2025-02-27","2025-02-27","2025-02-27","2025-02-28","2025-02-28","2025-02-27","2025-02-27","2025-02-27","2026-05-12","2026-03-18","2026-03-18","2025-02-28","2025-02-28","2026-03-09","2026-05-12","2026-05-16","2026-05-16","2025-05-20","2026-06-18","2025-06-17","2026-06-18","2025-06-17","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-06-20","2025-06-20","2026-05-01","2025-06-20","2025-08-29","2025-02-11","2025-02-19","2025-02-27","2025-02-27","2026-05-19","2026-02-13","2026-02-13","2026-02-13","2026-03-02","2026-03-03","2026-03-09","2026-03-09","2026-04-06","2026-04-06","2026-05-04","2026-06-18","2026-06-18"],"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":[["","","FINASTERIDE","5 MG","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","5 MG","","Select","Select",""],["","","PREGABALIN","25 MG","","Select","Select",""],["","","FLECAINIDE ACETATE","50 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","TESTOSTERONE","1.62%","","Select","Select",""],["","","VALSARTAN","160 MG","","Select","Select",""],["","","POTASSIUM CITRATE ER","1080 MG","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","0.05%","","Select","Select",""],["","","COMIRNATY 2024-25","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","20 MG","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","HYDROCORTISONE","2.50%","","Select","Select",""],["","","PREDNISONE","50 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":""}]}]}