{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PHYLLIS J DEWITT","gend":1,"currentgend":"","add":"2348 SE 93RD ST","city":"WAKARUSA","state":"KS","zip":"665469638","dob":"1951-08-13","age":"","mstatus":"","insh":"K44000522","cliId":"","pno":"7858362017","cno":"","email":"","ename":"","eno":"","pphy":"KELCIE STRECKER","ppno":"7857763322","pcpadd":"505 S PLUMMER AVE","pcpcity":"CHANUTE","pcpstate":"KS","pcpzip":"66502-3381","pcpcounty":"","pcpid":"","pcpname":"KANSAS MEDICAL CLINIC PA","plan":"BCBSKS","program":"Medicare","lob":"001","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1336572940","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44000522","medicareid":"3VX9NY2CE59","medicaidid":"3VX9NY2CE59","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","L814","L821","Z85820","Z08","R300","J449","G4733","B078","E782","B354","L84","Z87891","R918","J432","D485","Z7189","L905","N390","L570","D1801","Z85828","M1712","K219","M25562","E66811","M2392","Z6833","M7989","M7122","M7121","M25461","H524","I2510","F17210","M25362","I10","E1169","L255","H40003","T8149XA","Z96652","J441","M160","R5383","R3121","Z0130","L578","Z7984","M75122","R0602","R002","I119","R92323","F17219","Z01810","G8929","M169","Z471","L02416","Z79899","I517","R531","R6889","Z7409","E669","Z6832","M79671","E785","E1142","M159","M7731","Z4689","I781","D0472"],"date":["2025-07-15","2025-11-07","2024-05-29","2025-11-07","2026-05-07","2024-04-05","2025-08-18","2025-09-30","2024-05-29","2025-01-30","2024-07-17","2026-03-12","2025-07-30","2025-02-27","2024-07-30","2026-05-07","2026-05-07","2024-09-11","2024-09-26","2025-11-07","2024-11-07","2026-05-07","2025-09-30","2025-03-18","2025-03-06","2025-01-30","2024-12-31","2024-12-31","2024-12-10","2025-01-10","2024-12-31","2024-12-31","2024-12-30","2026-01-15","2025-08-18","2024-12-31","2026-01-15","2025-07-15","2025-07-15","2025-09-22","2025-09-30","2025-10-06","2025-09-30","2025-09-30","2025-09-28","2025-09-23","2025-11-07","2025-11-07","2025-01-15","2025-01-10","2025-02-18","2025-01-30","2025-01-30","2026-01-29","2025-02-19","2025-02-19","2025-05-30","2025-03-18","2025-03-18","2025-09-30","2025-09-30","2025-02-12","2025-02-25","2025-02-25","2025-02-25","2025-01-30","2025-01-30","2026-01-16","2026-01-15","2026-03-12","2026-03-12","2026-03-12","2026-03-12","2026-05-07","2026-06-18"],"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":[["","","NYSTATIN","","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","PRAVASTATIN SODIUM","80 MG","","Select","Select",""],["","","BENAZEPRIL HYDROCHLORIDE","40 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","100 MCG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","AREXVY","120 MCG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","DICLOFENAC SODIUM DR","75 MG","","Select","Select",""],["","","CELECOXIB","200 MG","","Select","Select",""],["","","BENAZEPRIL HCL","40 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","METHOCARBAMOL","750 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 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":""}]}]}