{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY H PETERSON","gend":0,"currentgend":"","add":"1503 N Nickelton St","city":"Wichita","state":"KS","zip":"67235","dob":"1956-04-30","age":"","mstatus":"","insh":"K44002773","cliId":"","pno":"3164094995","cno":"","email":"jpeterson747@gmail.com","ename":"","eno":"","pphy":"MICHAEL GRIMES","ppno":"3168329024","pcpadd":"1900 N AMIDON AVE","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67203-2125","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"007","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1972569028","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44002773","medicareid":"5MV1J97MP06","medicaidid":"5MV1J97MP06","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":["K219","Z0000","E119","E782","I10","Z86010","F32A","L729","K635","K5730","D123","M5431","H35463","H5053","H5203","H52223","H524","H2513","Z860100","R062","R0602"],"date":["2026-02-27","2026-02-27","2026-06-05","2026-02-27","2026-04-14","2024-09-18","2026-02-27","2024-08-26","2024-09-18","2024-09-18","2024-09-18","2024-11-01","2025-12-22","2024-12-16","2025-12-22","2025-12-22","2025-12-22","2025-12-22","2026-02-27","2026-06-05","2026-06-05"],"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":[["","","PREDNISONE","20 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","SIMVASTATIN","40 MG","","Select","Select",""],["","","VALSARTAN","160 MG","","Select","Select",""],["","","HUMALOG KWIKPEN","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","5 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS\/SENSOR\/GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","OZEMPIC","8 MG","","Select","Select",""],["","","JARDIANCE","25 MG","","Select","Select",""],["","","CONTOUR NEXT EZ BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","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":""}]}]}