{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONNIE S BERRY","gend":1,"currentgend":"","add":"1716 N CLARENCE AVE","city":"WICHITA","state":"KS","zip":"67203","age":"","mstatus":"","insh":"K44003191","cliId":"","pno":"3166199194","cno":"","email":"csberry@cox.net","ename":"","eno":"","pphy":"KRISTEN OCHSNER","ppno":"3165007207","pcpadd":"3730 N RIDGE ROAD","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67205-1235","pcpcounty":"","pcpid":"","pcpname":"US DERMATOLOGY PARTNERS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1716 N Clarence Ave","madd2":"","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"672031515","pcpfaxno":"","pcpnpi":"1265697510","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003191","medicareid":"5YY7ET3MR41","medicaidid":"5YY7ET3MR41","pcpFlag":"","dob":"1956-07-11"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40033","H35372","R5383","L821","Z1321","R92333","E7800","E559","M1611","M5450","M9903","M7910","R1013","R1031","R1032","R140","K219","I519","M1990","Z800","Z8541","Z791","Z87891","K449","K2960","R194","H25813","K2100","L820","L570","M19049","M5459","Z780","Z85828","Z7189","D1801","L814","L2989","E538","I9589","E785"],"date":["2025-04-28","2025-04-28","2024-10-02","2026-04-28","2024-10-02","2025-10-22","2025-12-09","2026-06-02","2025-02-05","2025-02-05","2025-02-05","2025-02-05","2025-04-01","2025-04-01","2025-04-01","2025-02-13","2025-02-13","2025-02-13","2025-02-13","2025-04-01","2025-02-13","2025-02-13","2025-02-13","2025-04-01","2025-04-01","2025-04-01","2025-04-28","2025-04-01","2026-04-28","2026-04-28","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-04-28","2026-04-28","2026-04-28","2026-06-02","2026-06-02","2026-06-02"],"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":[["","","OMEPRAZOLE DR","20 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","CELECOXIB","200 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":""}]}]}