{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERYL A SAWYER","gend":1,"currentgend":"","add":"4414 S DODGE AVE","city":"WICHITA","state":"KS","zip":"67217","dob":"1956-10-28","age":"","mstatus":"","insh":"K44003063","cliId":"","pno":"3168716638","cno":"","email":"A_HAPPY_OWL@YAHOO.COM","ename":"","eno":"","pphy":"SARAH ROOKER","ppno":"3162933455","pcpadd":"8533 E 32ND ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67226-2611","pcpcounty":"","pcpid":"","pcpname":"UKSM-WICHITA","plan":"BCBSKS","program":"Medicare","lob":"006","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1013685494","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003063","medicareid":"4MA8QC1MK66","medicaidid":"4MA8QC1MK66","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z794","G4710","M5136","M5126","M5416","R202","E668","Z6831","Z87891","Z01419","Z13820","Z1151","Z1231","E119","R12","M2550","R638","F32A","R413","N959","Z79890","K8689","E669","K2100","Z6832","Z86010","Z1331","B353","I10","J45909","D125","K635","K648","Z7984","Z880","K760","M79641","M8589","S80862A","L298","S80861A","T887XXA","M85852","E66811","Z860100","L509","L821","K219","R197","R030","E6601","E7800","E113399","E559","E785"],"date":["2026-04-01","2024-01-10","2024-01-25","2024-01-25","2024-01-25","2024-01-25","2024-07-24","2024-12-06","2024-05-20","2024-02-26","2024-02-26","2024-02-26","2024-07-24","2026-05-27","2024-02-26","2024-02-26","2024-02-26","2024-02-26","2024-02-26","2024-02-26","2024-02-29","2024-04-02","2025-05-05","2024-04-02","2024-10-14","2024-05-20","2024-11-20","2024-04-24","2024-05-20","2024-05-20","2024-05-20","2024-05-20","2024-05-20","2024-05-20","2024-05-20","2026-04-20","2024-07-24","2024-07-24","2024-08-15","2024-08-15","2024-09-10","2024-09-10","2024-10-02","2024-12-06","2024-10-14","2024-11-20","2024-12-31","2025-10-20","2025-10-20","2025-03-12","2025-03-12","2025-04-30","2025-05-05","2026-04-01","2026-04-20"],"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":[["","","ROSUVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","LISINOPRIL","2.5 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","PROPRANOLOL HYDROCHLORIDE","20 MG","","Select","Select",""],["","","VENLAFAXINE HYDROCHLORIDE ER","75 MG","","Select","Select",""],["","","MOUNJARO","5 MG","","Select","Select",""],["","","FARXIGA","10 MG","","Select","Select",""],["","","NEOMYCIN SULFATE","500 MG","","Select","Select",""],["","","OMEPRAZOLE DR","20 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","TERBINAFINE HYDROCHLORIDE","250 MG","","Select","Select",""],["","","ECONAZOLE NITRATE","1%","","Select","Select",""],["","","TRESIBA FLEXTOUCH","","","Select","Select",""],["","","LACTULOSE","10 GM","","Select","Select",""],["","","BD PEN NEEDLE\/NANO\/ULTRA -FINE\/32G X 4MM","","","Select","Select",""],["","","HUMALOG","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","Neomycin Tab","500 MG","","Select","Select",""],["","","Farxiga Tab","10 MG","","Select","Select",""],["","","Bd Pen Needl Mis 32Gx4Mm","","","Select","Select",""],["","","Econazole Cre 1%","","","Select","Select",""],["","","Rosuvastatin Tab","40 MG","","Select","Select",""],["","","Propranolol Tab","20 MG","","Select","Select",""],["","","Terbinafine Tab","250 MG","","Select","Select",""],["","","Lantus Solos Inj 100\/Ml","","","Select","Select",""],["","","Mounjaro Inj","5 MG","","Select","Select",""],["","","Humalog Inj 100\/Ml","","","Select","Select",""],["","","Venlafaxine Cap","75 MG","","Select","Select",""],["","","Mounjaro Inj 7.5\/0.5","","","Select","Select",""],["","","Lactulose Sol","10 GM","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Mounjaro Inj 2.5\/0.5","","","Select","Select",""],["","","Lisinopril Tab","2.5 MG","","Select","Select",""],["","","Azithromycin Tab","250 MG","","Select","Select",""],["","","Tresiba Flex Inj 100Unit","","","Select","Select",""],["","","Omeprazole Cap","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":""}]}]}