{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH B FINE","gend":1,"currentgend":"","add":"1550 S CEDAR ST","city":"OTTAWA","state":"KS","zip":"66067","age":"","mstatus":"","insh":"K44013837","cliId":"","pno":"7858060491","cno":"","email":"sarah.fine55@yahoo.com","ename":"","eno":"","pphy":"MAUREEN YOST","ppno":"7853549591","pcpadd":"330 ARKANSAS ST","pcpcity":"LAWRENCE","pcpstate":"KS","pcpzip":"66606-2442","pcpcounty":"","pcpid":"","pcpname":"LAWRENCE PAIN SPECIALISTS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT 310","add3":"","madd1":"1550 S CEDAR ST","madd2":"APT 310","madd3":"","mcity":"OTTAWA","mstate":"KS","mzip":"66067","pcpfaxno":"7855055319","pcpnpi":"1477985190","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44013837","medicareid":"4RE1YU1QE15","medicaidid":"4RE1YU1QE15","pcpFlag":"","dob":"1955-10-10"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M50221","M50223","M47812","Z7689","M5412","I517","I5189","R112","E119","R002","M4722","M79642","M50122","M2578","M9961","Z981","Z98890","I129","E1122","M7989","M810","Z794","R110","J3089","R918","K219","D1801","L918","L814","L570","R251","M4802","N1830","E669","Z6830","Z7984","Z7985","Z79899","R053","G4733","I10","M6530","R0600"],"date":["2026-01-27","2026-01-27","2026-01-27","2026-05-20","2026-04-29","2026-02-17","2026-02-17","2026-03-14","2026-03-14","2026-03-14","2026-01-30","2026-03-19","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-04-29","2026-03-31","2026-03-31","2026-04-29","2026-04-29","2026-04-29","2026-03-31","2026-04-29","2026-04-29","2026-04-29","2026-05-14","2026-05-14","2026-05-14","2026-05-14","2026-01-27","2026-01-27","2026-03-14","2026-03-14","2026-03-14","2026-03-14","2026-03-14","2026-03-14","2026-04-24","2026-04-24","2026-04-29","2026-04-29","2026-04-29"],"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":[["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","METHOCARBAMOL","500 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","AZELASTINE HYDROCHLORIDE","0.10%","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","10 MG","","Select","Select",""],["","","DIAZEPAM","5 MG","","Select","Select",""],["","","ACCU-CHEK GUIDE","","","Select","Select",""],["","","LYUMJEV KWIKPEN","","","Select","Select",""],["","","TOUJEO MAX SOLOSTAR","","","Select","Select",""],["","","NEBIVOLOL HYDROCHLORIDE","5 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","EMBECTA PEN NEEDLE\/ULTRA-FINE\/31G X 8MM","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","MYRBETRIQ","50 MG","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIPS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","JUBBONTI","60 MG","","Select","Select",""],["","","SUCRALFATE","1 GM","","Select","Select",""],["","","JARDIANCE","10 MG","","Select","Select",""],["","","METOCLOPRAMIDE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","FAMOTIDINE","20 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":""}]}]}