{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAX M THOMAS","gend":0,"currentgend":"","add":"409 W 11th St N","city":"Wichita","state":"KS","zip":"67203","dob":"1954-06-01","age":"","mstatus":"","insh":"K44003801","cliId":"","pno":"3168066651","cno":"","email":"maxmthomas54@gmail.com","ename":"","eno":"","pphy":"SPENCER DUNCAN","ppno":"3169754000","pcpadd":"641 N SENECA ST","pcpcity":"VALLEY CENTER","pcpstate":"KS","pcpzip":"67135","pcpcounty":"","pcpid":"","pcpname":"WICHITA FAMILY MEDICINE SPECIALISTS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1497934061","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003801","medicareid":"2QV2EM1GD27","medicaidid":"2QV2EM1GD27","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":["N401","I10","E038","E785","R9720","N010","C61","Z8546","K635","Z1211","K6389","N281","F845","Z136","Z126","Z125","Z131","E079","G252","N39498","F17210","R338","E7800","E039","Z79890","F17200","F840","F419","F32A","K219","R188","M549","M810","E291","H52223","Z789"],"date":["2024-02-07","2026-06-08","2024-01-26","2026-06-08","2025-06-02","2024-01-26","2026-06-08","2024-10-31","2024-04-02","2024-04-02","2024-04-15","2024-04-15","2024-10-28","2024-10-28","2024-10-28","2024-10-28","2024-10-28","2024-10-28","2024-10-28","2024-10-31","2024-10-31","2024-02-07","2024-02-07","2026-06-08","2025-06-09","2024-02-07","2024-02-07","2024-02-07","2024-02-07","2024-02-07","2024-04-15","2024-04-15","2025-06-09","2026-06-08","2025-08-13","2025-01-07"],"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":[["","","ESCITALOPRAM OXALATE","20 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","300 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","125 MCG","","Select","Select",""],["","","SIMVASTATIN","40 MG","","Select","Select",""],["","","Lisinopril Tab","20 MG","","Select","Select",""],["","","Simvastatin Tab","40 MG","","Select","Select",""],["","","Bupropion Tab","300 MG","","Select","Select",""],["","","Levothyroxin Tab","125 MCG","","Select","Select",""],["","","Escitalopram Tab","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":""}]}]}