{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA D DINGUS","gend":1,"currentgend":"","add":"1029 S Bracken St","city":"Wichita","state":"KS","zip":"67207","dob":"1955-09-23","age":"","mstatus":"","insh":"K44002208","cliId":"","pno":"3169930392","cno":"","email":"ds19733165@att.net","ename":"","eno":"","pphy":"TARA KATZ","ppno":"3166134976","pcpadd":"612 N ANDOVER RD","pcpcity":"ANDOVER","pcpstate":"KS","pcpzip":"67002-9778","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"006","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1029 S Bracken St","madd2":"","madd3":"","mcity":"Wichita","mstate":"KS","mzip":"67207","pcpfaxno":"","pcpnpi":"1386962215","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44002208","medicareid":"2X91HM9JY97","medicaidid":"2X91HM9JY97","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":{"diag":["H6122","L570","L720","L814","L821","Z85828","Z872","L820","D485","T887XXA","H35371","H33312","S50812A","M1711","R238","I878","D225","Z471","M1712","F411","Z96652","E785","Z8589","M25762","Z882","Z885","S99922A","D122","K644","Z860101","Z800","K635","R92323","J0190","Z7189","X32XXXA","Z08","Z780","M85851","M85852","M8580"],"date":["2024-01-17","2026-02-12","2025-02-06","2026-02-12","2026-02-12","2026-02-12","2024-02-06","2024-02-06","2025-02-06","2024-05-17","2026-03-20","2026-03-20","2024-06-25","2024-07-15","2024-08-05","2024-08-05","2026-02-12","2024-09-27","2024-08-21","2025-12-31","2025-08-26","2025-12-31","2025-12-31","2024-08-22","2024-08-22","2024-08-22","2025-06-03","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2025-12-23","2025-12-31","2026-02-12","2026-02-12","2026-02-12","2025-04-08","2025-04-08","2025-04-08","2025-04-08"],"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":[["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","FLUOROURACIL","5%","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","SHINGRIX","50\/0.5 ML","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Triamcinolon Cre 0.1%","","","Select","Select",""],["","","Sertraline Tab","100 MG","","Select","Select",""],["","","Shingrix Inj","50\/0.5 ML","","Select","Select",""],["","","Amoxicillin Tab","500 MG","","Select","Select",""],["","","Fluorouracil Cre 5%","","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","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":""}]}]}