{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLAUDIA S JONES","gend":1,"currentgend":"","add":"1306 NORTHWESTERN ST","city":"IOLA","state":"KS","zip":"66749","age":"","mstatus":"","insh":"K44013166","cliId":"","pno":"3162437052","cno":"3162437052","email":"","ename":"","eno":"","pphy":"JOSEPH FRIESEN","ppno":"3166309300","pcpadd":"1923 N WEBB RD","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67235-1100","pcpcounty":"","pcpid":"","pcpname":"MID AMERICA ORTHOPEDICS LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1306 NORTHWESTERN ST","madd2":"","madd3":"","mcity":"IOLA","mstate":"KS","mzip":"66749","pcpfaxno":"","pcpnpi":"1467621904","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44013166","medicareid":"6W05RE2MM58","medicaidid":"6W05RE2MM58","pcpFlag":"","dob":"1950-11-09"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R112","R109","Z170","R339","Z79811","G629","I495","R531","E782","S42002A","I129","N189","J449","N390","K219","E038","W1839XA","Z4789","E785","R0600","Z8673","Z950","Z720","W06XXXA","W19XXXA","N2581","E559","I10","E211","E790","R2240","F05","F0390","M546","G8929","S066X0A","F1120","N1830","E039","F418","E876","G4700","S0003XA","Z90710","Z87440","Z853","Z96649","Z79899","F17210","G8911","R296","Z888","Z885","S065X0A","E8720","S42022A","F0393","J439","F0394","I959","Z9049","R402142","R402252","R402352","M79671","Z87891","Z91041","Z79891","K5900","N3000"],"date":["2026-03-19","2026-03-07","2026-05-14","2026-05-14","2026-05-14","2026-05-14","2026-04-21","2026-03-18","2026-05-15","2026-02-04","2026-03-03","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-11","2026-03-03","2026-02-11","2026-02-11","2026-02-11","2026-02-11","2026-01-11","2026-01-30","2026-03-03","2026-03-03","2026-03-27","2026-03-03","2026-03-03","2026-03-03","2026-03-21","2026-03-21","2026-03-27","2026-03-27","2026-01-12","2026-01-12","2026-02-04","2026-02-04","2026-01-12","2026-01-12","2026-01-12","2026-01-12","2026-01-12","2026-02-04","2026-02-04","2026-01-12","2026-03-21","2026-01-12","2026-01-12","2026-01-12","2026-01-12","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-03-07","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-03-21","2026-03-07","2026-03-07"],"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":[["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","ANASTROZOLE","1 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","LEVETIRACETAM","500 MG","","Select","Select",""],["","","CALCITRIOL","0.25 MCG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","50 MCG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","CITALOPRAM HYDROBROMIDE","10 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","10 MG","","Select","Select",""],["","","QUETIAPINE FUMARATE","25 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100 MG","","Select","Select",""],["","","MYRBETRIQ","25 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","MIRABEGRON ER","25 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":""}]}]}