{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA K CLARK","gend":1,"currentgend":"","add":"548 Road 240","city":"Americus","state":"KS","zip":"66835","age":"","mstatus":"","insh":"K44013561","cliId":"","pno":"6207946145","cno":"","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":"M3AK44013561","medicareid":"7JV2EC9AX93","medicaidid":"","pcpFlag":"","dob":"1951-02-27"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N3289","W19XXXA","K8020","G35D","D649","F419","F32A","N3281","E785","W1830XA","Z7409","G8911","R270","S1989XA","D62","S0993XA","Z96651","S199XXA","R200","M4802","M2578","S6991XA","R0789","M25512","S3993XA","Z043","M542","W010XXA","M25561","S0181XA","Z23","M1990","Z8673","Z87891","M5134","M47816","Z79899","E782","E663","R32","M150","G43009","E2839","Z122","R296","L03211","Z4802","Z981","Z136","Z130","Z13228"],"date":["2026-05-22","2026-05-23","2026-05-22","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-22","2026-05-22","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-14","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-06-05","2026-06-05","2026-06-05","2026-03-09","2026-05-14","2026-05-14","2026-05-14"],"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":[["","","EMGALITY","120 MG","","Select","Select",""],["","","AVONEX","30 MCG","","Select","Select",""],["","","MECLIZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","10 MG","","Select","Select",""],["","","LIDOCAINE","5%","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4 MG","","Select","Select",""],["","","CELECOXIB","200 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","100 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","60 MG","","Select","Select",""],["","","SCOPOLAMINE","1 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","300 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","GABAPENTIN","300 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":""}]}]}