{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERRY S HILLEBERT","gend":1,"currentgend":"","add":"513 E MONROE ST","city":"PITTSBURG","state":"KS","zip":"66762","age":"","mstatus":"","insh":"K44010276","cliId":"","pno":"7853933544","cno":"","email":"shillebert@gmail.com","ename":"","eno":"","pphy":"JOSEPH HAWKINS","ppno":"7855055475","pcpadd":"600 E 20TH ST","pcpcity":"EUDORA","pcpstate":"KS","pcpzip":"66046-5238","pcpcounty":"","pcpid":"","pcpname":"LMH HEALTH PRIMARY","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"Lot 41C","add3":"","madd1":"513 E MONROE ST","madd2":"","madd3":"","mcity":"PITTSBURG","mstate":"KS","mzip":"66762","pcpfaxno":"","pcpnpi":"1326219916","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44010276","medicareid":"4K73UH1QC97","medicaidid":"4K73UH1QC97","pcpFlag":"","dob":"1958-03-07"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z8719","S8991XA","M25461","G8911","X501XXA","Z7689","R300","N281","M5450","G5602","E1142","Z79899","Z7985","Z794","Z7984","I10","F329","E782","M25561","E785","Z87891","H401421","H40001","E119","H2513","M23331","E1165","H52223","H5203","R92322","K219","K449","R000","E8729","N179","E871","E8342","M5489","G8929","R1110","R197","E8720","R1013","Z112","K2950","T182XXA","Y738","E66811","Z6833","F1290","R112","R1032","M2241","S83231A","R600","M65961","N6489","R9230","E860","R064","D259","M5430","Z9049","K222","F1590","E669","Z6831"],"date":["2025-07-01","2025-09-25","2025-09-25","2025-07-31","2025-07-31","2026-06-15","2025-07-25","2025-07-25","2025-07-25","2025-08-06","2026-06-15","2025-08-06","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2025-08-18","2025-08-18","2025-09-29","2026-06-15","2026-06-15","2025-10-10","2025-11-21","2025-11-21","2025-11-21","2025-09-29","2025-09-29","2025-11-21","2025-11-21","2025-12-11","2025-02-20","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-08-04","2025-02-10","2025-02-11","2025-02-11","2025-02-11","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2025-06-10","2025-06-10","2025-09-25","2025-09-25","2025-09-25","2025-09-25","2025-11-21","2025-12-11","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-02-20","2025-02-20","2026-06-15","2026-06-15"],"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":[["","","LATANOPROST","0.01%","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MICROLET LANCETS","","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","RELION PEN NEEDLES 32G X 4MM","","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","BENAZEPRIL HYDROCHLORIDE","20 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000 MG","","Select","Select",""],["","","ATENOLOL","50 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","ALPRAZOLAM","0.25 MG","","Select","Select",""],["","","DIAZEPAM","5 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","SUCRALFATE","1 GM","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","ONDANSETRON HYDROCHLORIDE","4 MG","","Select","Select",""],["","","Sucralfate Tab","1 GM","","Select","Select",""],["","","Atenolol Tab","50 MG","","Select","Select",""],["","","Microlet Mis Lancets","","","Select","Select",""],["","","Benazepril Tab","20 MG","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Latanoprost Sol 0.005%","","","Select","Select",""],["","","Diazepam Tab","5 MG","","Select","Select",""],["","","Contour Tes Next","","","Select","Select",""],["","","Alprazolam Tab","0.25 MG","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Ondansetron Tab","4 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Cyclobenzapr Tab","10 MG","","Select","Select",""],["","","Metformin Tab","1000 MG","","Select","Select",""],["","","Rosuvastatin Tab","10 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":""}]}]}