{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DUANE L BALDRIDGE","gend":0,"currentgend":"","add":"624 WEST ST","city":"EMPORIA","state":"KS","zip":"66801","age":"","mstatus":"","insh":"K44003605","cliId":"","pno":"6207578545","cno":"6203423015","email":"DLEEBALDRIDGE@MAIL.COM","ename":"","eno":"","pphy":"AMANDA RUXTON","ppno":"6203432500","pcpadd":"2522 W 15TH AVE","pcpcity":"EMPORIA","pcpstate":"KS","pcpzip":"66801-2588","pcpcounty":"","pcpid":"","pcpname":"INTEGRITY MEDICAL LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"6203432828","pcpnpi":"1457511321","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003605","medicareid":"8GH5G47GC86","medicaidid":"","pcpFlag":"","dob":"1953-08-29"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["H9313","F5101","R7303","R7989","E890","E291","R9389","L0100","M1612","K4090","N401","N402","M542","M9902","M546","M9903","M5451","M87052","J3489","I10","N400","Z7982","B351","E785","C61","M87059","M533","G8929","R351","J449","Z87891","R55","M47812","M47814","S0990XA","W1830XA","Y92019","R9720","K644","K5790","Z789","R0609","K921","R198","M25552","F411","L570","M5450","M9901","M25551","M4316","M47816","M25559","M47819","N390","Z79899","Z923","K5730","K648","K6289","K625","Z8546","K520","J40","R059","E673","R7309","R338","K621","R0789"],"date":["2024-04-12","2025-06-26","2026-04-01","2024-12-23","2025-07-25","2024-04-25","2025-06-26","2024-04-25","2024-04-25","2024-04-25","2026-03-23","2024-04-17","2025-06-25","2025-02-04","2025-06-25","2024-05-31","2024-05-31","2024-07-02","2024-07-02","2026-04-01","2024-06-18","2024-09-13","2024-07-19","2026-04-01","2026-04-08","2024-04-17","2024-08-05","2024-08-05","2024-09-13","2024-09-13","2026-01-25","2025-06-26","2025-06-25","2025-06-25","2025-06-25","2025-06-25","2025-06-25","2025-07-16","2025-10-30","2025-10-30","2025-06-05","2025-09-30","2025-10-20","2025-11-13","2025-03-14","2025-01-03","2025-01-03","2025-02-04","2025-02-04","2025-02-05","2025-02-05","2025-02-05","2025-02-05","2025-02-05","2026-03-23","2026-01-25","2025-12-02","2025-10-30","2025-10-30","2026-01-27","2025-12-02","2025-12-02","2026-02-25","2026-01-27","2026-01-25","2026-04-01","2026-04-08","2026-05-04","2026-06-11","2026-01-25"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","HYDROXYZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100 MG","","Select","Select",""],["","","METHOCARBAMOL","500 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","ORGOVYX","120 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE PHOSPHATE","30 MG","","Select","Select",""],["","","AMITRIPTYLINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","PROCTO-MED HC","2.50%","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","CELECOXIB","100 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","AREXVY","120 MCG","","Select","Select",""],["","","FLUOROURACIL","2%","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50 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":""}]}]}