{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONNIE L HENRY","gend":0,"currentgend":"","add":"777 N SILVER SPRINGS BLV","city":"WICHITA","state":"KS","zip":"67212","dob":"1942-10-25","age":"","mstatus":"","insh":"K44003244","cliId":"","pno":"3163085286","cno":"","email":"ron.henry@att.net","ename":"","eno":"","pphy":"JILL AUGUSTINE","ppno":3166899111,"pcpadd":"929 N ST FRANCIS ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"37208-3079","pcpcounty":"","pcpid":"","pcpname":"SOUND PHYSICIANS OF TEXAS III","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT 1111","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":1548399751,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6D82MA1CA87","medicaidid":"6D82MA1CA87","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":[]},{"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":[["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","HYDRALAZINE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE","","","Select","Select",""],["","","ALLOPURINOL","100 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","RISPERIDONE","1 MG","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","TRADJENTA","5 MG","","Select","Select",""],["","","LISINOPRIL","30 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","AZITHROMYCIN","500 MG","","Select","Select",""],["","","MEMANTINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","HUMALOG KWIKPEN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","INSULIN LISPRO KWIKPEN","","","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":""}]}]}