{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARK W CLARK","gend":0,"currentgend":"","add":"101 N KICKAPOO ST","city":"SOUTH HAVEN","state":"KS","zip":"67140","age":"","mstatus":"","insh":"K44010416","cliId":"","pno":"6204401014","cno":"","email":"JOYCECLARK0207@GMAIL.COM","ename":"","eno":"","pphy":"SHANA JARMER","ppno":"6203263301","pcpadd":"507 E 16TH","pcpcity":"WELLINGTON","pcpstate":"KS","pcpzip":"67152-2828","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1699842799","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44010416","medicareid":"8JR7XA3XV50","medicaidid":"8JR7XA3XV50","pcpFlag":"","dob":"1956-12-31"},{"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":["I480","I10","E119","I3139","I2510","Z125","L03116","R200","J40","I340","E1151","E785","F17210","Z951","Z7982","Z7984","Z79899","Z7901","Z7902","K921","Z720","J329","H52223","H524","D128","Z1211","Z1212","K5731","Z95820","Z95818","Z87891"],"date":["2026-04-28","2025-11-11","2026-04-28","2025-11-11","2025-11-11","2025-02-18","2025-02-18","2025-04-23","2025-04-23","2025-11-11","2026-06-05","2025-11-11","2026-06-05","2026-06-05","2026-06-05","2026-06-05","2026-06-05","2025-11-11","2025-02-05","2026-04-28","2026-04-28","2026-04-24","2026-05-09","2026-05-09","2026-06-08","2026-06-08","2026-06-08","2026-06-05","2026-06-05","2026-06-05","2026-06-10"],"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":[["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","METOLAZONE","5 MG","","Select","Select",""],["","","SPIRONOLACTONE","100 MG","","Select","Select",""],["","","BUMETANIDE","2 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","METHOCARBAMOL","750 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","Metolazone Tab","5 MG","","Select","Select",""],["","","Smz\/Tmp Ds Tab 800-160","","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Pot Chloride Tab","20 MEQ","","Select","Select",""],["","","Spironolact Tab","100 MG","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Bumetanide Tab","2 MG","","Select","Select",""],["","","Methocarbam Tab","750 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Cefdinir Cap","300 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":""}]}]}