{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JERRY M RANDALL","gend":0,"currentgend":"","add":"423 E 5th St","city":"Rantoul","state":"KS","zip":"66079","dob":"1945-09-19","age":"","mstatus":"","insh":"K44014101","cliId":"","pno":"7852143819","cno":"7852143819","email":"","ename":"","eno":"","pphy":"JOHN GOLLIER","ppno":"7852421620","pcpadd":"1418 S MAIN ST","pcpcity":"OTTAWA","pcpstate":"KS","pcpzip":"66067-3544","pcpcounty":"","pcpid":"","pcpname":"OTTAWA FAMILY PHYSICIANS CHTD","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"Box 172","madd2":"","madd3":"","mcity":"Rantoul","mstate":"KS","mzip":"66079","pcpfaxno":"","pcpnpi":"1104857911","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44014101","medicareid":"3AJ1G62HR19","medicaidid":"3AJ1G62HR19","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","I129","M79641","M4312","C3491","R918","C329","D472","C9110","D649","Z85118","Y842","R509","R5383","R519","N1832","Z950","R0602","R5381","C9190","I442","R051","G5601","C3411","C323","E1122","E1169","I480","E782","G8929","M1711","Z923","J441","J189"],"date":["2026-01-22","2026-04-09","2026-01-29","2026-01-29","2026-04-28","2026-05-29","2026-05-29","2026-06-12","2026-03-02","2026-03-02","2026-05-29","2026-03-02","2026-03-03","2026-03-03","2026-03-03","2026-04-09","2026-04-28","2026-03-20","2026-03-20","2026-04-09","2026-04-23","2026-04-28","2026-01-29","2026-02-16","2026-04-28","2026-04-09","2026-04-09","2026-04-09","2026-04-09","2026-04-09","2026-04-09","2026-04-28","2026-04-28","2026-04-28"],"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":[["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","ROPINIROLE HCL","1 MG","","Select","Select",""],["","","FENOFIBRATE","145 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","AREXVY","120 MCG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","SIMVASTATIN","40 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 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":""}]}]}