{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUTH A KNOLLA","gend":1,"currentgend":"","add":"2023 S GOLDEN HILLS ST","city":"WICHITA","state":"KS","zip":"67209","dob":"1955-10-05","age":"","mstatus":"","insh":"K44001425","cliId":"","pno":"3162007446","cno":"","email":"ruthknolla@gmail.com","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":"007","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1053323972","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44001425","medicareid":"1RE5UW4JJ79","medicaidid":"1RE5UW4JJ79","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79899","E8941","N952","E782","F329","J302","L570","M530","M9902","M546","M9903","M5441","R252","M9906","M25551","M25651","H5201","H52221","H524","F32A","E7800","M5011","M5442","Z780","Z23","Z1331","Z1231"],"date":["2026-02-27","2025-01-20","2026-02-27","2026-02-27","2026-02-27","2026-02-27","2024-01-16","2024-09-23","2025-06-03","2025-06-03","2025-06-03","2024-09-23","2024-09-23","2024-09-23","2024-09-23","2024-09-23","2024-12-16","2024-12-16","2024-12-16","2024-08-23","2024-08-23","2025-06-03","2025-06-03","2026-02-27","2026-02-27","2026-02-27","2026-02-27"],"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":[["","","SIMVASTATIN","40 MG","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","10 MG","","Select","Select",""],["","","PREMARIN","0.625 MG","","Select","Select",""],["","","ESTRADIOL","0.01%","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","IPRATROPIUM BROMIDE","0.06%","","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":""}]}]}