{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HYE C SPRINGOB","gend":1,"currentgend":"","add":"3212 S OAK ST","city":"WICHITA","state":"KS","zip":"67217","age":"","mstatus":"","insh":"K44003567","cliId":"","pno":"3165227775","cno":"","email":"williamspringob@att.net","ename":"","eno":"","pphy":"EDWARD WEIPPERT","ppno":"3167214544","pcpadd":"8200 W CENTRAL AVE","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67212-3661","pcpcounty":"","pcpid":"","pcpname":"WEST WICHITA FAMILY PHYSICIANS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3212 S OAK ST","madd2":"","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"67217","pcpfaxno":"","pcpnpi":"1992813950","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003567","medicareid":"4AM9V06YN10","medicaidid":"4AM9V06YN10","pcpFlag":"","dob":"1942-07-16"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I209","I4510","E118","I10","G629","E0590","E782","Z8249","K219","R739","E785","E079","M79674","R252","E119","Z794","Z743","H04123","H353130","R053","Z23","E1165","H21523","H353131","H16223","I361","H5203","H52223","H524","Z8673","R42","Z91148","D333","H903","K649","G8929","M25562","H832X1","R9431","R0989","R9389","Z01812","L603","X500XXA","Y9289","H35371","Z13820","R0609","H401133"],"date":["2024-01-15","2025-02-21","2025-02-21","2026-06-03","2025-02-21","2025-02-21","2026-03-25","2026-03-25","2026-03-25","2026-01-26","2026-06-03","2026-06-03","2024-07-24","2026-06-03","2026-03-25","2026-03-25","2024-03-17","2024-02-27","2024-02-27","2024-06-07","2025-02-10","2026-01-26","2025-03-25","2025-03-25","2025-08-07","2024-08-02","2026-01-20","2026-01-20","2026-01-20","2024-11-27","2026-03-25","2024-03-18","2025-06-06","2025-06-24","2025-06-04","2025-06-04","2026-05-13","2025-01-13","2025-02-21","2025-02-28","2025-02-28","2025-02-28","2025-04-15","2025-05-20","2025-05-20","2026-01-20","2026-01-26","2026-03-25","2026-03-19"],"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":[["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","OMEPRAZOLE DR","20 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","CITALOPRAM HYDROBROMIDE","20 MG","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS\/SENSOR\/GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","LUMIGAN","0.01%","","Select","Select",""],["","","ALISKIREN","150 MG","","Select","Select",""],["","","OMEGA-3-ACID ETHYL ESTERS","1 GM","","Select","Select",""],["","","CLOTRIMAZOLE\/BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","DROPLET PEN NEEDLES 32GX4MM","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","AZOPT","1%","","Select","Select",""],["","","FREESTYLE LIBRE 2 PLUS\/SENSOR\/FLASH GLUCOSE MONITOR SYSTEM","","","Select","Select",""],["","","FREESTYLE LIBRE 3\/READER\/GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","HYDROCORTISONE","2.50%","","Select","Select",""],["","","AMOXICILLIN","250\/5 ML","","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","300 MG","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","OMEPRAZOLE","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":""}]}]}