{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOE P GAULTNEY","gend":0,"currentgend":"","add":"4935 CHEYENNE LN","city":"MC LOUTH","state":"KS","zip":"660544159","age":"","mstatus":"","insh":"K44010635","cliId":"","pno":"7858408280","cno":"","email":"JPGAULTNEY@YAHOO.COM","ename":"","eno":"","pphy":"ROSE MUELLER","ppno":"7858417297","pcpadd":"1803 W 6TH ST","pcpcity":"LAWRENCE","pcpstate":"KS","pcpzip":"66044-1368","pcpcounty":"","pcpid":"","pcpname":"HEARTLAND MEDICAL CLINIC INC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"7858560375","pcpnpi":"1336697408","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44010635","medicareid":"5PA9H36UH45","medicaidid":"5PA9H36UH45","pcpFlag":"","dob":"1950-12-23"},{"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":["H401121","E118","I10","R0789","I4510","R9431","I4729","R072","M25512","I8002","M7542","M7522","E8342","M353","G8929","Z6837","Z713","Z7182","I119","I4720","Z7689","E7800","I441","I739","K760","R7303","E66812","Z6839","Z950","Z955","Z79899","I2510","M51360","M48061","E1140","Z1211","Z6834"],"date":["2025-11-07","2025-02-10","2025-02-27","2025-02-27","2025-02-27","2025-02-27","2025-01-07","2025-02-27","2025-02-27","2025-03-05","2025-03-03","2025-03-03","2025-04-16","2025-04-16","2025-04-16","2025-04-16","2026-01-06","2026-01-06","2025-04-16","2025-04-08","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2026-01-06","2025-06-02","2025-06-02","2025-02-27","2025-04-28","2025-04-28","2026-01-06","2026-01-06","2026-01-06"],"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":[["","","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Losartan\/Hct Tab 100-12.5","","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Metoprol Suc Tab","50 MG","","Select","Select",""],["","","Gabapentin Cap","100 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Cyclobenzapr Tab","10 MG","","Select","Select",""],["","","Rosuvastatin Tab","20 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","Select","Select",""],["","","Azithromycin Tab","250 MG","","Select","Select",""],["","","Prednisone Tab","10 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":""}]}]}