{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARCIA M SELL","gend":1,"currentgend":"","add":"100 2ND ST","city":"HARTFORD","state":"KS","zip":"66854","dob":"1961-10-13","age":"","mstatus":"","insh":"K44012945","cliId":"","pno":"6203669537","cno":"","email":"marciamsell@gmail.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"100 2ND ST","madd2":"","madd3":"","mcity":"HARTFORD","mstate":"KS","mzip":"66854","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44012945","medicareid":"1ND8Q81EP62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","M47816","M5116","M5416","M47817","K5730","K760","M51369","Z87891","J449","G4733","Z91199","K7581","E66811","Z6833","K069","Z98890","M5080","M5184","J438","Z967","Z978","Z981","M4716","I10","R739","E782","R197","K219","K649","R195","Z8719","K644","K648","R198","R32","G4700","F5101","E785","K5792","E6609","G8929","K625","F17200","E559","Z131","Z130","Z13220","Z13228","Z01818","R799","R791","N390","N959","M48062","M48061","Z4789"],"date":["2026-03-06","2026-03-06","2026-03-06","2026-03-06","2026-01-15","2026-01-15","2026-01-15","2026-05-01","2026-03-18","2026-03-18","2026-03-18","2026-03-18","2026-03-18","2026-03-18","2026-03-18","2026-03-18","2026-03-18","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-05-01","2026-03-18","2026-04-20","2026-04-20","2026-04-20","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-02-09","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-01-15","2026-03-06","2026-03-06","2026-03-06","2026-03-03","2026-03-03","2026-05-01","2026-05-01","2026-05-01"],"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":[["","","TRAZODONE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","IBUPROFEN","800 MG","","Select","Select",""],["","","ESTRADIOL","0.01%","","Select","Select",""],["","","METHOCARBAMOL","500 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","CELECOXIB","200 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","BUSPIRONE HCL","15 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","ZEPBOUND","5\/0.5 ML","","Select","Select",""],["","","ZEPBOUND KWIKPEN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TEMAZEPAM","7.5 MG","","Select","Select",""],["","","SPIRIVA RESPIMAT","1.25 MCG","","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":""}]}]}