{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY D MCCOY","gend":1,"currentgend":"","add":"191 S 135TH ST W","city":"WICHITA","state":"KS","zip":"67235","dob":"1947-01-25","age":"","mstatus":"","insh":"7FY9F93WK36","cliId":"","pno":"3163807155","cno":"","email":"","ename":"","eno":"","pphy":"MELISSA METHVIN","ppno":3166862111,"pcpadd":"8444 W 21ST ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67211-3900","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"006","region":"","aligned":"","ano":"","add2":"UNIT 1055","add3":"","madd1":"191 S 135TH ST W","madd2":"UNIT 1055","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"67235","pcpfaxno":"","pcpnpi":1346426285,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7FY9F93WK36","medicaidid":"7FY9F93WK36","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":[["","","Comirnaty Inj 2024-25","","","Select","Select",""],["","","Comirnaty Inj 30\/.3Ml","","","Select","Select",""],["","","Valsart\/Hctz Tab 320-12.5","","","Select","Select",""],["","","Triamcinolon Cre 0.1%","","","Select","Select",""],["","","Prevnar 20 Inj","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Metoprol Tar Tab","100 MG","","Select","Select",""],["","","Jardiance Tab","25 MG","","Select","Select",""],["","","Latanoprost Sol 0.005%","","","Select","Select",""],["","","Onetouch Tes Ultra","","","Select","Select",""],["","","Clobetasol Cre 0.05%","","","Select","Select",""],["","","Ketoconazole Cre 2%","","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Metformin Tab","1000 MG","","Select","Select",""],["","","Cefdinir Cap","300 MG","","Select","Select",""],["","","Citalopram Tab","20 MG","","Select","Select",""],["","","Omeprazole Cap","40 MG","","Select","Select",""],["","","Simvastatin Tab","20 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":""}]}]}