{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEANNETTE K FISHER","gend":1,"currentgend":"","add":"8106 W 34th St N","city":"Wichita","state":"KS","zip":"67205","dob":"1939-02-07","age":"","mstatus":"","insh":"3C24WX8EV97","cliId":"","pno":"3162583936","cno":"","email":"","ename":"","eno":"","pphy":"KIMBERLY KENAS","ppno":3167214910,"pcpadd":"8200 W CENTRAL AVE","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67212-3661","pcpcounty":"","pcpid":"","pcpname":"WEST WICHITA FAMILY PHYSICIANS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":1053323972,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3C24WX8EV97","medicaidid":"3C24WX8EV97","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]},{"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":[["","","Nystatin Sus 100000","","","Select","Select",""],["","","Metronidazol Tab","500 MG","","Select","Select",""],["","","Ondansetron Tab","8 MG","","Select","Select",""],["","","Lidocaine Sol 2% Oral","","","Select","Select",""],["","","Smz\/Tmp Ds Tab 800-160","","","Select","Select",""],["","","Vancomycin Cap","125 MG","","Select","Select",""],["","","Nitroglycern Sub","0.4 MG","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Oseltamivir Cap","75 MG","","Select","Select",""],["","","Clindamycin Cap","300 MG","","Select","Select",""],["","","Dasatinib Tab","140 MG","","Select","Select",""],["","","Doxycyc Mono Cap","100 MG","","Select","Select",""],["","","Mirtazapine Tab","15 MG","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Fluconazole Tab","150 MG","","Select","Select",""],["","","Doxycycl Hyc Cap","100 MG","","Select","Select",""],["","","Levothyroxin Tab","50 MCG","","Select","Select",""],["","","Ciprofloxacn Tab","250 MG","","Select","Select",""],["","","Ipratropium\/ Sol Albuter","","","Select","Select",""],["","","Ursodiol Tab","250 MG","","Select","Select",""],["","","Sertraline Tab","25 MG","","Select","Select",""],["","","Midodrine Tab","5 MG","","Select","Select",""],["","","Klor-Con M20 Tab","20 MEQ","","Select","Select",""],["","","Pot Cl Micro Tab","20 MEQ","","Select","Select",""],["","","Mupirocin Oin 2%","","","Select","Select",""],["","","Furosemide Tab","40 MG","","Select","Select",""],["","","Dexamethason Tab","4 MG","","Select","Select",""],["","","Metoprol Suc Tab","25 MG","","Select","Select",""],["","","Oxycodone Tab","5 MG","","Select","Select",""],["","","Famotidine Tab","20 MG","","Select","Select",""],["","","Cefepime Inj","2 GM","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Levofloxacin Tab","500 MG","","Select","Select",""],["","","Amlodipine Tab","5 MG","","Select","Select",""],["","","Atorvastatin Tab","40 MG","","Select","Select",""],["","","Valacyclovir Tab","500 MG","","Select","Select",""],["","","Diltiazem Cap","180 MG","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","Select","Select",""],["","","Eliquis Tab","5 MG","","Select","Select",""],["","","Amiodarone Tab","200 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":""}]}]}