{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUTH E MAHON","gend":1,"currentgend":"","add":"3624 SE TOMAHAWK DR","city":"TECUMSEH","state":"KS","zip":"66542","dob":"1959-10-28","age":"","mstatus":"","insh":"K44010705","cliId":"","pno":"7858065275","cno":"","email":"rmkansas@yahoo.com","ename":"","eno":"","pphy":"JOY-ANN TABANOR-GAYLE","ppno":"7853546000","pcpadd":"4525 W 6TH ST","pcpcity":"LAWRENCE","pcpstate":"KS","pcpzip":"66604-1301","pcpcounty":"","pcpid":"","pcpname":"LMH HEALTH PRIMARY CARE","plan":"BCBSKS","program":"Medicare","lob":"007","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1104232404","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44010705","medicareid":"7NR8PT9AJ48","medicaidid":"7NR8PT9AJ48","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K2211","K315","K2100","M961","C720","K2091","G8929","I639","M5412","M159","R5383","M19041","M19042","M19072","I10","E785","I429","E039","E063","Z7901","Z882","Z8673","Z8589","Z888","M533","Z7902","J0100"],"date":["2025-05-08","2025-05-08","2025-05-08","2025-02-04","2025-02-04","2025-02-03","2025-03-12","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2025-05-08","2025-05-08","2025-05-08","2025-02-03","2025-02-03","2025-02-03","2025-05-08","2025-05-08","2025-05-08","2025-05-08","2025-02-04","2025-05-08","2026-04-16"],"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":[["","","LEVOTHYROXINE SODIUM","88 MCG","","Select","Select",""],["","","GABAPENTIN","400 MG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","80 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","40 MG","","Select","Select",""],["","","LEVETIRACETAM","750 MG","","Select","Select",""],["","","Gabapentin Cap","400 MG","","Select","Select",""],["","","Levothyroxin Tab","88 MCG","","Select","Select",""],["","","Oxycod\/Apap Tab 10-325Mg","","","Select","Select",""],["","","Esomepra Mag Cap","40 MG","","Select","Select",""],["","","Cyclobenzapr Tab","5 MG","","Select","Select",""],["","","Levetiraceta Tab","750 MG","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Atorvastatin Tab","80 MG","","Select","Select",""],["","","Omeprazole Cap","40 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":""}]}]}