{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY ROMEREIM","gend":1,"currentgend":"","add":"529 W ASPEN ST","city":"WICHITA","state":"KS","zip":"67217","dob":"1988-07-31","age":"","mstatus":"","insh":"12688872825479","cliId":"","pno":3163034198,"cno":"","email":"ASHLEY.ROMEREIM@GMAIL.COM","ename":"","eno":"","pphy":"ANTHONY SHAVER","ppno":3167898222,"pcpadd":"1640 E TALL TREE RD","pcpcity":"DERBY","pcpstate":"KS","pcpzip":"67837","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"ACA","lob":"INDIVIDUAL METALLIC","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"529 W ASPEN ST","madd2":"","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"67217","pcpfaxno":3169627100,"pcpnpi":1871962456,"currentgendcomment":"","pphycomment":"","uniqueid":"XSN851966779","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F900","F331","F411","M62830","M549","G90A","I951","Z124","Z01419","N8110","K469","Z1151"],"date":["2026-02-03","2026-02-03","2026-02-03","2026-01-21","2026-01-21","2026-02-06","2026-02-06","2026-01-22","2026-01-22","2026-01-22","2026-01-22","2026-01-22"],"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":[["","","LO LOESTRIN FE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","IVABRADINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","XELJANZ XR","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","MINOXIDIL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","LISDEXAMFETAMINE DIMESYLATE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}