{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERYN J CUNNINGHAM","gend":1,"currentgend":"","add":"303 W 6th St","city":"Haysville","state":"KS","zip":"67060","age":"","mstatus":"","insh":"K44012403","cliId":"","pno":"3165167059","cno":"3165167059","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44012403","medicareid":"4D34W32XE84","medicaidid":"4D34W32XE84","pcpFlag":"","dob":"1968-11-29"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M2041","E65","E6601","N952","N951","F331","I82513","E782","M19011","M19012","S90414D","M14671","G629","M19071","M170","M1612","G8929","F419","F32A","G4733","E039","E785","G43909","J309","R32","Z791","Z7984","Z7901","Z792","Z79891","Z89421"],"date":["2026-03-26","2026-03-10","2026-03-27","2026-03-10","2026-03-10","2026-03-10","2026-03-10","2026-03-10","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-03-27"],"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":[["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","GABAPENTIN","600 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","5 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","ESTRADIOL\/NORETHINDRONE ACETATE","0.5 MG","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","125 MCG","","Select","Select",""],["","","NITROFURANTOIN MACROCRYSTALS","100 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","150 MG","","Select","Select",""],["","","COMBIPATCH","","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","FLUOXETINE HYDROCHLORIDE","60 MG","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","LAMOTRIGINE","200 MG","","Select","Select",""],["","","SPIRONOLACTONE","50 MG","","Select","Select",""],["","","XARELTO","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":""}]}]}