{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERNADETTE SCOTT","gend":1,"currentgend":"","add":"1208 N NAVAJO DR","city":"SAINT MARYS","state":"KS","zip":"665361859","age":"","mstatus":"","insh":"K44011141","cliId":"","pno":"5302146555","cno":"","email":"bscottdesign@yahoo.com","ename":"","eno":"","pphy":"MARIAH KALMA","ppno":"7852726860","pcpadd":"2921 SW WANAMAKER DR","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66614-5328","pcpcounty":"","pcpid":"","pcpname":"KANSAS MEDICAL CLINIC PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1208 N NAVAJO DR","madd2":"","madd3":"","mcity":"SAINT MARYS","mstate":"KS","mzip":"66536","pcpfaxno":"","pcpnpi":"1104580851","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44011141","medicareid":"6EF0PY4QH09","medicaidid":"6EF0PY4QH09","pcpFlag":"","dob":"1956-07-27"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D485","D229","L603","L659","D230","E7800","R7989","R17","Z0000","Z1589","U099","F3341","E782","L988","X32XXXS","N958","R609","Z79890","Z1211","Z1239","M25561","G9331","G4700","Z62890","Z634","Z818","Z880"],"date":["2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2026-03-12","2026-03-12","2026-03-12","2026-03-10","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-27","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-27"],"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":[["","","CHLORHEXIDINE GLUCONATE","0.12%","","Select","Select",""],["","","PROGESTERONE","100 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","2 MG","","Select","Select",""],["","","ABIGALE","0.5 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","IBUPROFEN","800 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":""}]}]}