{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES M WATTS","gend":0,"currentgend":"","add":"1000 N 9th St","city":"Independence","state":"KS","zip":"67301","dob":"1942-10-29","age":"","mstatus":"","insh":"K44012907","cliId":"","pno":"6203307767","cno":"6203307767","email":"","ename":"","eno":"","pphy":"SCOTT FOX","ppno":"6208205800","pcpadd":"1133 SW TOPEKA BLVD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"67357-4948","pcpcounty":"","pcpid":"","pcpname":"LCMC PHYSICIANS GROUP","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1396977815","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44012907","medicareid":"1V06JG2TY40","medicaidid":"1V06JG2TY40","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N401","N138","N433","I890","D696","I2510","L03116","E781","I10","E1142","C8248","J209","R051","Z1331","E119","Z5111","Z5112","R112","C833A","E1169","J449","J309","C8598","J0101","J410","R222","R221","R933","R059"],"date":["2026-01-08","2026-02-18","2026-02-18","2026-06-09","2026-06-09","2026-01-05","2026-01-08","2026-01-08","2026-03-18","2026-04-20","2026-05-08","2026-04-28","2026-04-28","2026-04-28","2026-04-10","2026-06-05","2026-06-03","2026-06-03","2026-05-08","2026-06-09","2026-06-09","2026-06-09","2026-06-09","2026-06-09","2026-06-09","2026-02-14","2026-02-14","2026-03-10","2026-05-19"],"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":[["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","80 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","FENOFIBRATE","54 MG","","Select","Select",""],["","","ONDANSETRON HYDROCHLORIDE","8 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","DROPLET PEN NEEDLES 32GX4MM","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS\/SENSOR\/GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","ALBUTEROL SULFATE","0.08%","","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":""}]}]}