{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H E MASSEY","gend":0,"currentgend":"","add":"403 Brookwood St","city":"Lansing","state":"KS","zip":"66043","age":"","mstatus":"","insh":"K44011968","cliId":"","pno":"9135301217","cno":"","email":"Mass05.hem@gmail.com","ename":"","eno":"","pphy":"GALEN SEYMOUR","ppno":"9136806200","pcpadd":"3550 S 4TH ST","pcpcity":"LEAVENWORTH","pcpstate":"KS","pcpzip":"66048-5071","pcpcounty":"","pcpid":"","pcpname":"PROVIDENCE MEDICAL GROUP","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1912019274","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44011968","medicareid":"4FG9EV1QK32","medicaidid":"4FG9EV1QK32","pcpFlag":"","dob":"1952-12-17"},{"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":["Z0130","L219","L720","I10","E782","N528","Z125","Z8546","M25461","M10061","Z6829","Z8739","M25762","M25761","M25561","M19041","M7989","M25441"],"date":["2025-11-06","2025-11-06","2025-11-06","2026-04-28","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-02-05","2026-02-05","2026-04-28","2026-05-13","2026-02-05","2026-02-05","2026-02-05","2026-05-13","2026-05-13","2026-05-13"],"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":[["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","ATENOLOL","100 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","TRIAMTERENE\/HYDROCHLOROTHIAZIDE","50 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","COLCHICINE","0.6 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":""}]}]}