{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HARVEY R YOUNG","gend":0,"currentgend":"","add":"506 N Young St","city":"Caldwell","state":"KS","zip":"67022","age":"","mstatus":"","insh":"K44010616","cliId":"","pno":"6205171229","cno":"","email":"scoobyde2000@yahoo.com","ename":"","eno":"","pphy":"AMANDA AST","ppno":"3165006000","pcpadd":"9300 E 29TH ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67226-2183","pcpcounty":"","pcpid":"","pcpname":"ENDOCRINE CENTER OF KANSAS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"3164440409","pcpnpi":"1255834735","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44010616","medicareid":"7U74H67HH62","medicaidid":"7U74H67HH62","pcpFlag":"","dob":"1942-08-23"},{"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":["E1065","Z9641","I10","E785","G4733","E119","E782","M1990","E10649","Z8679","G2581","E109","I2510","K219","R4182","F0390","F39","S72142A","J9601","N179","F0393","D62","Z794","Z7982","Z79899","E875"],"date":["2026-05-04","2026-03-31","2026-05-08","2026-05-04","2026-05-08","2025-10-06","2025-02-12","2025-05-14","2026-05-04","2025-05-14","2026-05-04","2026-05-08","2026-05-08","2026-05-08","2026-05-08","2026-05-08","2026-05-08","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04"],"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":[["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","60 MG","","Select","Select",""],["","","ROPINIROLE HCL","1 MG","","Select","Select",""],["","","MEMANTINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","DONEPEZIL HCL","10 MG","","Select","Select",""],["","","CARVEDILOL","3.125 MG","","Select","Select",""],["","","TELMISARTAN","80 MG","","Select","Select",""],["","","ROPINIROLE HYDROCHLORIDE","3 MG","","Select","Select",""],["","","CELECOXIB","200 MG","","Select","Select",""],["","","INSULIN LISPRO","","","Select","Select",""],["","","CITALOPRAM HYDROBROMIDE","20 MG","","Select","Select",""],["","","HUMALOG","","","Select","Select",""],["","","BAQSIMI TWO PACK","3 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Ropinirole Tab","3 MG","","Select","Select",""],["","","Celecoxib Cap","200 MG","","Select","Select",""],["","","Telmisartan Tab","80 MG","","Select","Select",""],["","","Humalog Inj 100\/Ml","","","Select","Select",""],["","","Insulin Lisp Inj 100\/Ml","","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Donepezil Tab","10 MG","","Select","Select",""],["","","Carvedilol Tab","3.125 MG","","Select","Select",""],["","","Citalopram Tab","20 MG","","Select","Select",""],["","","Atorvastatin Tab","40 MG","","Select","Select",""],["","","Amlodipine Tab","10 MG","","Select","Select",""],["","","Isosorb Mono Tab","60 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":""}]}]}