{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN MARTINEZ","gend":1,"currentgend":"","add":"7271 QUIVAS ST","city":"DENVER","state":"CO","zip":"80221","dob":"1937-12-28","age":"","mstatus":"","insh":101397738,"cliId":"","pno":"7205393374","cno":"7205393374","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"WESTSIDE ADULT MEDICAL HOME","plan":"Denver Health","program":"Medicare","lob":"MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7271 QUIVAS ST","madd2":"","madd3":"","mcity":"DENVER","mstate":"CO","mzip":"80221","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"101397738","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","1","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["English Lrg Prt"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","M80831D","Z23","I4892","R262","M0579","M810","R946","R7989","M8000XD","E860","E861","F323","R627","N3289","H04123","D2210","H02883","H02886","I214","J189","J9811","R079","Z79899","D759","I447","F333","F429","Z8659","Z9151","I480","F29","E785","I2510","N390","N189","M25531","M25562","W19XXXA","W06XXXA","Z9181","K5901","E43","R5381","R4189","F32A","R339","N1330","M069","E559","K5900","R296","I70203","B351","L603","L84","K219","F419","D649","I10","N1830","M25511","R10813","F418","E46","N1831","E782","I4439","I4710","I459","R634","E876","D696","E0590","E039","I491","S32039A","S32029A","M80031D","M80032D","Z743","I499","F329","R29898","M25522","R52","N3090","N1339","R519","R000","R54","M79672","I5181","G9341","J069","Z0000","L988","M25559","M1990","S0990XA","S3992XA","S199XXA","S3991XA","S3993XA","S299XXA","M79671","R197","I130","R059","M5136","Z8639","Z6821","R9431","I4589","H524","H52223","E870","G9340","R2689","R531","T07XXXA","M546","R410","Z8679","U071","I25810","D692","Z79631","Z79620","R195","Z452","H9313","N179","S93122A","R937","I5022","I081","I5020","E871","I083","Z87891","F22","N139","D61818","R0989","Z09","Z872","L858","M7551","M7552","Z791","R509","N182","J479","R918","Z7189","I110","F23","I440","S90421A","S90422A","S90422D","I5021","S59902A","X58XXXA","M19011","M19012","Z043","Z7901","G43909","R778","F339","I4719","I493","P919","D7589","E8339","S5002XA","W182XXA","S90421D"],"date":["2026-01-26","2025-11-05","2024-10-14","2024-12-31","2025-04-01","2025-09-08","2026-01-05","2025-07-23","2025-11-19","2025-09-08","2023-11-15","2023-11-20","2025-11-26","2024-01-24","2024-02-07","2022-09-14","2022-09-14","2022-09-14","2022-09-14","2023-02-18","2023-02-19","2023-02-19","2023-12-30","2024-06-06","2023-01-30","2026-01-05","2024-05-07","2024-01-05","2024-01-09","2023-11-23","2026-01-05","2024-05-01","2025-07-29","2025-12-03","2025-10-31","2025-10-28","2023-12-30","2025-09-22","2023-12-30","2023-12-30","2023-12-31","2024-02-09","2024-04-02","2024-01-29","2024-02-07","2025-10-31","2024-11-22","2024-11-22","2025-12-03","2025-02-20","2026-01-05","2024-08-22","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2024-05-06","2025-08-20","2024-04-02","2024-04-02","2026-01-05","2026-01-05","2024-10-31","2026-01-05","2025-10-29","2025-03-15","2025-09-23","2024-12-31","2025-03-03","2024-12-31","2025-12-03","2025-02-11","2025-09-24","2026-01-05","2025-10-29","2025-03-03","2025-12-03","2025-10-31","2022-03-30","2022-03-30","2024-12-31","2023-11-27","2024-01-13","2024-01-19","2024-01-16","2024-01-19","2024-01-24","2024-02-26","2024-12-31","2024-12-31","2026-01-13","2023-01-05","2023-06-20","2024-07-01","2025-03-14","2025-04-14","2026-01-13","2026-01-05","2026-01-05","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2022-11-01","2023-03-09","2024-01-22","2022-05-27","2022-08-27","2022-08-27","2022-08-27","2023-02-19","2023-02-21","2023-03-31","2023-03-31","2023-11-22","2023-11-20","2023-12-30","2024-01-19","2023-12-30","2023-12-30","2023-12-31","2024-10-15","2024-10-25","2025-05-16","2025-03-12","2025-09-08","2025-09-08","2024-01-30","2024-01-30","2023-06-08","2023-11-24","2022-10-26","2022-10-26","2023-02-22","2023-02-22","2023-03-01","2023-03-01","2023-02-28","2023-06-30","2023-11-20","2024-02-09","2022-12-07","2024-02-20","2025-02-03","2025-02-03","2025-01-27","2025-03-27","2025-03-27","2025-03-27","2025-03-15","2025-12-03","2023-11-15","2023-11-15","2024-01-16","2023-03-31","2023-11-23","2024-02-05","2024-02-15","2024-03-07","2024-03-14","2023-03-31","2023-11-15","2023-11-15","2025-04-02","2025-04-02","2023-11-15","2023-11-20","2024-01-01","2023-02-19","2023-12-10","2025-03-03","2025-03-03","2025-03-17","2023-11-21","2023-11-21","2023-11-15","2023-11-15","2024-02-22"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","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":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"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":""}]}]}