{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON K STINEMETZE","gend":1,"currentgend":"","add":"601 OXFORD DR","city":"MCPHERSON","state":"KS","zip":"67460","dob":"1950-11-16","age":"","mstatus":"","insh":"K44003128","cliId":"","pno":"6202416460","cno":"","email":"tstinemetze@cox.net","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003128","medicareid":"1C02VA0QK87","medicaidid":"1C02VA0QK87","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":["M5450","I2510","I10","E7800","E119","Z955","Z7902","I517","E785","Z780","M85851","M85852","Z860100","E669","E7849","K5140","Z1211","H26492","Z961","H26493","H04123","D122","K635","K5730","Z794","E038","Z6837","M5416","R82998","G250","L309","B3731","M48061","Z538","I7090","M8589","Z7984","R251","Z9849","E113293","Z7982","Z79899","H35372","G4733","R809","R109","M8580","H938X1","M109","R1031","G4730","Z9989","G629","R040"],"date":["2024-01-02","2026-03-02","2026-02-03","2026-02-03","2026-03-02","2026-02-03","2026-02-03","2024-01-18","2026-03-02","2024-08-13","2024-08-13","2024-08-13","2024-10-23","2026-02-04","2026-02-04","2024-10-23","2024-10-23","2024-10-03","2025-09-11","2024-10-03","2025-05-15","2024-10-23","2024-10-23","2024-10-23","2026-02-03","2024-11-06","2024-11-06","2024-01-18","2024-04-05","2025-06-27","2024-07-08","2024-07-08","2024-01-24","2024-01-24","2024-08-13","2024-08-13","2024-10-16","2025-11-13","2025-09-11","2025-09-11","2026-02-03","2025-02-04","2025-04-15","2025-10-28","2025-10-28","2025-10-28","2025-10-28","2025-12-03","2025-02-25","2025-02-25","2026-02-03","2026-06-11","2026-03-02","2026-03-16"],"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":[["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","VALSARTAN","320 MG","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","80 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","VENLAFAXINE HYDROCHLORIDE ER","75 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","PRIMIDONE","50 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","BISOPROLOL FUMARATE","10 MG","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","MOUNJARO","5 MG","","Select","Select",""],["","","SOLIQUA 100\/33","","","Select","Select",""],["","","PEN NEEDLES 32GX4MM","","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE","100 MG","","Select","Select",""],["","","HUMALOG KWIKPEN","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","METRONIDAZOLE","0.75%","","Select","Select",""],["","","NEOMYCIN\/POLYMYXIN\/HC","1%","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","Metronidazol Gel 0.75%","","","Select","Select",""],["","","Pen Needles Mis 32Gx4Mm","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Lantus Solos Inj 100\/Ml","","","Select","Select",""],["","","Valsartan Tab","320 MG","","Select","Select",""],["","","Humalog Kwik Inj 100\/Ml","","","Select","Select",""],["","","Venlafaxine Cap","75 MG","","Select","Select",""],["","","Dexcom G7 Mis Receiver","","","Select","Select",""],["","","Dexcom G7 Mis Sensor","","","Select","Select",""],["","","Contour Tes Next","","","Select","Select",""],["","","Soliqua Inj 100\/33","","","Select","Select",""],["","","Primidone Tab","50 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Mounjaro Inj 2.5\/0.5","","","Select","Select",""],["","","Neo\/Poly\/Hc Sol 1% Otic","","","Select","Select",""],["","","Allopurinol Tab","300 MG","","Select","Select",""],["","","Atorvastatin Tab","80 MG","","Select","Select",""],["","","Amlodipine Tab","5 MG","","Select","Select",""],["","","Azithromycin Tab","250 MG","","Select","Select",""],["","","Bisoprol Fum Tab","10 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":""}]}]}