{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEROY S CHAMBERS","gend":0,"currentgend":"","add":"1317 SW Van Buren","city":"Topeka","state":"KS","zip":"66612","age":"","mstatus":"","insh":"K44011299","cliId":"","pno":"9012839297","cno":"","email":"","ename":"","eno":"","pphy":"STEVEN TAKI","ppno":"7853546000","pcpadd":"1133 SW TOPEKA BLVD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66604-1301","pcpcounty":"","pcpid":"","pcpname":"COTTON O NEIL","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1317 SW Van Buren","madd2":"","madd3":"","mcity":"Topeka","mstate":"KS","mzip":"66612","pcpfaxno":"","pcpnpi":"1659805992","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44011299","medicareid":"4PQ8XQ7VU26","medicaidid":"","pcpFlag":"","dob":"1951-11-06"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R531","R059","R509","R944","R82998","Z87891","D638","J449","I2510","F321","Z86718","Z8719","I675","I739","N1831","R112","K921","R7401","D72829","R791","R7982","I6930","D500","E782","I10","S32050G","I639","D631","I129","R1110","Z79899","D649","K31811","K449","D62","I69351","Z7982","K264","Z125","R410","F32A","G4700","R404","R569","R252","I69319","E785","G8929","M1711","I69398","Z1339","Z0000","K219","G894","I25119","E875","R7402","Z8673","K922","N179","R7989","I952","I959","R0689","F1110","R946","R825","G40909","R64","G928","G8111","G459","G629","K279","I69851","M26601","Z20822","I6523","F329","I493","I252","Z993","L89152","R4189","R55","M4856XA","Z681","R636","I69353","L89896","R4701","Z95828","F419","Z713","Z7409","Z48815","N189","F418","T402X1A","F05","E8720","G9389","H53461","G9341","M1990","K269","F1510","Z9849","Z556","Z9181","D6862","Z122"],"date":["2025-08-18","2025-07-09","2025-07-09","2025-09-02","2025-09-02","2025-10-08","2025-09-04","2026-03-19","2026-04-03","2026-03-19","2025-10-08","2025-09-04","2025-10-08","2026-03-19","2026-03-19","2025-07-22","2025-07-22","2025-09-02","2025-08-03","2025-07-22","2025-08-03","2025-08-25","2026-04-01","2025-10-08","2025-10-02","2025-07-27","2025-09-02","2025-10-08","2025-10-10","2025-08-28","2025-09-03","2025-08-22","2025-08-07","2025-07-24","2025-10-10","2026-03-19","2025-10-08","2025-08-08","2025-10-01","2025-09-04","2025-10-08","2025-09-04","2025-09-29","2025-09-29","2026-02-24","2025-09-03","2026-03-19","2026-05-08","2026-05-08","2025-09-02","2025-10-02","2025-10-02","2026-03-19","2026-03-19","2025-10-02","2025-10-08","2025-09-02","2025-09-04","2025-08-09","2025-09-04","2025-09-04","2025-09-03","2025-09-02","2025-09-02","2025-09-02","2025-09-02","2025-09-02","2025-09-04","2025-09-04","2025-09-04","2025-09-04","2025-08-03","2025-08-25","2025-08-25","2025-07-22","2025-07-22","2025-09-03","2025-07-17","2025-07-17","2025-07-17","2025-10-08","2025-09-24","2025-07-17","2025-07-17","2025-07-17","2025-07-24","2025-09-03","2025-07-24","2025-07-27","2025-07-27","2025-08-07","2025-08-07","2025-10-08","2025-08-07","2025-08-07","2025-08-08","2025-09-24","2025-08-08","2025-09-03","2025-09-03","2025-09-03","2025-09-03","2025-09-03","2025-10-08","2025-10-08","2025-10-08","2025-10-08","2025-10-08","2025-10-08","2025-09-24","2026-03-19","2026-04-03"],"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":[["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","SUCRALFATE","1 GM","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","LEVETIRACETAM","500 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","HYDRALAZINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE PHOSPHATE","30 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":""}]}]}