{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON F CHURCHILL","gend":1,"currentgend":"","add":"102 WALNUT ST","city":"Wellsville","state":"KS","zip":"66092","dob":"1945-11-04","age":"","mstatus":"","insh":"K44013195","cliId":"","pno":"7853936216","cno":"7273483734","email":"travelinglady@embarqmail.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT 22","add3":"","madd1":"PO BOX 571","madd2":"","madd3":"","mcity":"Wellsville","mstate":"KS","mzip":"66092","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44013195","medicareid":"1Q70TV4AV02","medicaidid":"1Q70TV4AV02","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1142","E6601","I890","E785","Z794","Z9013","Z853","J069","I10","L84","B351","I83893","R051","Z86711","R531","Z9229","M810","Z7983","M5450","Z7901","D649","R600","I872","L989","L97211","C44719","Z7689","E119","D509","I2699","C50919","L0390","M85831","E11622","Z7984","L03115"],"date":["2026-04-11","2026-03-10","2026-05-26","2026-03-10","2026-06-02","2026-03-10","2026-05-04","2026-03-10","2026-05-11","2026-03-30","2026-04-06","2026-05-11","2026-04-11","2026-05-04","2026-04-11","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-11","2026-05-26","2026-05-26","2026-05-26","2026-06-02","2026-06-02","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-05-26","2026-05-26","2026-05-26"],"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":[["","","METFORMIN HYDROCHLORIDE","1000 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","25 MG","","Select","Select",""],["","","PRAVASTATIN SODIUM","20 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","5 MG","","Select","Select",""],["","","ALENDRONATE SODIUM","70 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","CLINDAMYCIN HCL","300 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","LEVOFLOXACIN","500 MG","","Select","Select",""],["","","TRESIBA FLEXTOUCH","","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","","","Select","Select",""],["","","JARDIANCE","25 MG","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","EMBECTA PEN NEEDLE\/NANO 2ND GEN\/32G X 4MM","","","Select","Select",""],["","","ELIQUIS","5 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":""}]}]}