{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN HESBURGH","gend":1,"currentgend":"","add":"1450 N WASHINGTON ST APT 202","city":"DENVER","state":"CO","zip":"80203","dob":"1959-08-17","age":"","mstatus":"","insh":2000103128,"cliId":"","pno":"9703063092","cno":"9703063092","email":"","ename":"","eno":"","pphy":"TREFILEK, BENJAMIN T","ppno":3034366000,"pcpadd":"DENVER HEALTH ORTHOPEDICS,777 BANNOCK ST","pcpcity":"DENVER","pcpstate":"CO","pcpzip":"80217","pcpcounty":"","pcpid":"","pcpname":"EASTSIDE ADULT MEDICAL HOME","plan":"Denver Health","program":"Medicare","lob":"MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1450 N WASHINGTON ST APT 202","madd2":"","madd3":"","mcity":"DENVER","mstate":"CO","mzip":"80203","pcpfaxno":3034366572,"pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2000103128","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","1","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K2920","N179","R109","K2090","M810","Z1211","M8000XS","Z13220","S72142A","S42002D","E8352","G40909","R569","M8008XS","K529","M8008XA","S7292XD","R200","G40109","G40119","Z0000","R202","S0083XA","R296","Z01818","R112","S0181XA","I69354","S3993XA","S0990XA","S22070A","F10939","K226","G40101","A4151","R000","I491","I252","D61818","G928","F10251","F10230","S069X9A","F10121","S22079A","K449","R4182","R160","K760","R9341","K922","R1110","E876","E8342","I493","S32020A","S32050A","S22030A","S22040A","S22050A","M5384","M5137","R29890","M9953","M4317","I6789","Z743","R279","Z748","B2790","I4891","G8384","G40919","R9401","Z1231","R92333","R921","R918","M47812","X58XXXA","S72121A","Z043","R079","R69","M79662","M25562","M79652","M25532","W19XXXA","R29818","R251","H2513","H43393","H52223","S0285XA","S02842A","R519","S42002A","M5489","I10","M5431","Z5941","Z7409","S0101XA","Y92009","S79912A","S79911A","M8588","R110","G9349","S22088A","M8448XA","R9431","G319","I679","R410","H524","R531","G9340","E46","R636","S22089A","M6281","F10239","E878","F10120","R55","R630","G40019","L989","Z7689","L309","D692","Z8543","Z872","Z681","K7010","D539","D696","M5386","S22049A","E8720","K9289","F17210","R030","Z720","Z741","K911","Z1212","K2950","K644","Z800","K649","Z980","J984","S299XXA","D62","I4892","R52","G4089","R509","M25551","W1830XA","R29810","R100","R1022","R262","R9089","F0390","M84412A","M5450","M4184","S22080A","M438X6","Z9181","F1021","R2689","R197","Z993","H5203","H52203","Z460","R413","Z09","R1312","R9082","Z79899","M80052D","H43813","G9341","Z0389","E8339","K2100","F10930","S72102A","R29898","N3001","B9620","Z780","R7989","R4781","G3184","M87052","R0902","M958","S72002A","S7292XA","D72829","I110","F1010","M25552","G3189","M4692","F10231","Z98890","M79605","R2681","E8729","M542","R1084","R198","R440","D509","M4802","R0789","G8929","W050XXA","Z90710","Z90722","E869","K2289","I5A","Z91148","E871","M47814","R627","R1013","W1839XA","Z8781","M8000XD","M25539","F10139","Z4789","I517","M3119","F1020","Z8659","I214","M1812","R442","R9439","I080","I3139","S0003XA","R1111","M47816","S42022A","I639","F10920","Y908","M438X4","I4949"],"date":["2023-12-15","2023-12-15","2023-12-27","2024-04-10","2026-01-30","2024-04-11","2025-11-28","2024-07-09","2024-07-22","2026-01-12","2024-09-17","2026-01-30","2025-11-12","2024-12-19","2025-02-03","2025-03-31","2026-01-01","2025-07-12","2026-01-27","2025-12-16","2025-05-02","2025-05-26","2025-06-27","2025-11-10","2025-08-21","2025-11-08","2025-08-19","2025-09-03","2025-10-06","2025-10-31","2024-07-24","2023-07-22","2023-12-15","2024-07-26","2024-08-05","2025-09-05","2024-07-21","2025-11-07","2023-06-19","2023-06-20","2023-06-20","2023-06-20","2025-09-24","2023-07-11","2023-07-11","2024-04-03","2025-11-11","2023-07-23","2023-12-15","2023-07-23","2023-12-17","2025-07-11","2024-07-21","2024-07-21","2025-11-07","2024-07-20","2024-07-20","2024-07-24","2024-07-24","2024-07-24","2024-07-23","2024-07-23","2024-07-23","2024-07-23","2024-07-23","2024-07-26","2025-11-16","2024-08-01","2024-08-01","2024-08-04","2025-10-01","2024-10-10","2024-11-17","2025-01-27","2025-02-07","2025-02-07","2025-02-07","2025-11-10","2025-03-14","2025-09-05","2025-05-14","2025-11-08","2025-08-20","2025-06-27","2025-07-10","2025-07-10","2025-07-10","2025-07-10","2025-11-10","2025-07-11","2025-07-11","2025-08-21","2025-08-21","2025-12-18","2025-08-21","2025-08-19","2025-08-19","2025-09-05","2025-10-06","2025-10-03","2025-10-10","2025-10-10","2025-10-10","2025-10-31","2025-10-31","2025-11-07","2025-11-07","2025-11-07","2025-11-10","2025-11-16","2025-11-16","2025-11-16","2025-11-11","2025-11-11","2025-11-11","2025-11-16","2025-12-18","2025-12-23","2026-01-30","2026-01-30","2026-01-23","2026-01-16","2026-01-16","2023-07-24","2024-01-06","2023-05-20","2023-08-07","2025-07-30","2025-12-16","2022-11-21","2022-11-21","2023-03-25","2023-03-25","2025-11-17","2023-03-25","2023-03-25","2023-04-18","2023-07-23","2023-06-19","2023-07-11","2023-07-11","2023-07-23","2023-12-27","2023-12-27","2023-12-27","2023-12-27","2023-12-27","2024-07-22","2024-04-03","2024-04-03","2024-04-03","2024-04-11","2024-04-11","2024-04-11","2024-07-20","2025-10-06","2024-07-23","2024-08-05","2025-05-26","2024-11-15","2024-11-15","2025-05-14","2025-05-14","2025-07-12","2025-09-23","2025-10-06","2025-11-07","2025-09-24","2025-09-05","2025-11-10","2025-11-10","2025-11-11","2025-11-11","2025-11-11","2025-11-18","2025-11-17","2025-11-08","2025-09-24","2026-01-13","2025-12-18","2025-12-18","2025-12-18","2023-05-28","2024-10-16","2025-11-24","2025-11-10","2025-12-16","2024-08-09","2025-07-31","2023-04-14","2023-06-17","2023-09-17","2023-09-18","2023-12-15","2024-07-21","2024-08-05","2024-08-05","2024-08-05","2025-01-14","2025-03-14","2025-07-11","2025-10-03","2025-09-24","2025-11-07","2025-11-07","2024-07-21","2024-07-26","2025-03-14","2025-04-24","2025-11-18","2025-09-26","2025-10-31","2025-10-31","2023-04-16","2025-01-17","2025-06-30","2023-04-19","2023-07-22","2023-07-11","2023-12-27","2024-04-17","2024-07-23","2024-07-23","2024-10-10","2025-07-11","2025-07-11","2025-07-11","2025-07-30","2025-07-30","2025-08-20","2025-08-20","2025-03-14","2025-03-14","2025-03-14","2025-11-11","2025-11-08","2025-11-08","2025-11-08","2026-01-27","2026-01-12","2022-10-22","2023-06-17","2023-07-11","2023-07-23","2023-10-25","2024-07-22","2024-07-22","2025-03-14","2025-06-23","2023-04-13","2024-07-27","2024-07-27","2024-07-27","2023-06-17","2023-07-24","2023-07-11","2024-07-21","2024-07-27","2023-05-20","2023-05-20","2023-07-11","2024-08-05"],"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":[["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","DIVALPROEX SODIUM","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LACOSAMIDE","","","Select","Select",""],["","","LEVOFLOXACIN","","","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":""}]}]}