{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MONICA LOPEZ RAMIREZ","gend":1,"currentgend":"","add":"3111 W 22ND AVE","city":"DENVER","state":"CO","zip":"80211","dob":"1965-09-13","age":"","mstatus":"","insh":1020473168,"cliId":"","pno":"7204211247","cno":"7204211247","email":"","ename":"","eno":"","pphy":"LANDE, MICHELE A","ppno":3032340445,"pcpadd":"ANESTHESIA AND PAIN MANAGEMENT,2201 WADSWORTH BLVD","pcpcity":"LAKEWOOD","pcpstate":"CO","pcpzip":"80001","pcpcounty":"","pcpid":"","pcpname":"DH PAV G ADULT MEDICAL HOME","plan":"Denver Health","program":"Medicare","lob":"MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 25","add3":"","madd1":"3111 W 22ND AVE","madd2":"APT 25","madd3":"","mcity":"DENVER","mstate":"CO","mzip":"80211","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1020473168","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z029","J4550","E113592","E113491","H25813","H52223","Z23","J45909","M25571","F419","E1142","F331","M79604","R109","R112","R9431","R1032","L408","S80212A","U071","M549","E1140","L400","H2511","H2512","E113493","E1122","R55","Z1231","R0602","H5213","H52203","H524","I081","F330","E109","K219","I10","E785","R52","Z743","R110","W19XXXA","H4312","H259","E113393","J9690","F1220","N12","F1290","E119","F439","Z961","Z87891","F320","R251","J4520","K5900","Z9981","M25562","R937","M25561","F411","G20","R059","J329","Z8616","R030","D7210","J302","R92323","Z13820","M8589","Z780","D7219","J310","R0609","M5416","G2111","Z8709","R0601","R6881","R768","Z0189","Z1211","Z48810","Z0184","J3489","F99","R1013","M25572","M79672","J8283","M47897","M5126","I252","M5440","K760","A6000","R509","A419","M4727","N200","R002"],"date":["2025-12-11","2026-01-31","2025-11-14","2025-11-14","2025-08-06","2026-01-27","2024-05-09","2026-01-22","2023-08-15","2023-05-04","2024-10-08","2024-05-09","2025-03-20","2023-05-09","2023-05-09","2023-05-09","2023-05-26","2023-10-18","2023-08-15","2023-11-07","2024-02-01","2024-11-19","2025-10-08","2025-09-17","2025-09-03","2025-10-13","2025-11-12","2022-03-24","2025-11-03","2023-05-09","2024-12-18","2022-09-16","2026-01-27","2022-10-04","2023-01-24","2023-01-24","2023-03-13","2025-09-17","2023-01-24","2023-05-09","2023-05-09","2023-05-09","2023-08-15","2025-03-12","2022-05-10","2023-11-13","2022-10-03","2022-10-10","2023-02-27","2025-12-11","2023-03-13","2024-05-09","2025-11-14","2026-01-22","2022-01-27","2023-03-21","2023-03-15","2023-05-15","2023-06-06","2022-03-24","2022-03-24","2022-03-23","2022-09-20","2022-09-20","2023-10-20","2023-11-13","2023-11-13","2024-03-07","2025-05-05","2025-05-05","2025-11-03","2025-11-05","2025-11-05","2025-11-05","2025-12-11","2025-12-11","2024-05-06","2022-08-05","2023-03-21","2022-06-29","2022-06-29","2022-06-29","2022-09-26","2023-01-27","2022-11-14","2025-10-29","2025-10-16","2022-07-19","2023-03-21","2023-05-09","2023-08-15","2023-08-15","2024-09-16","2022-07-27","2022-05-15","2022-01-01","2024-05-09","2024-05-09","2024-05-09","2024-05-09","2024-05-09","2022-07-27","2023-05-26","2023-04-28"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDROCORTISONE","","","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":""}]}]}