{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEE J PREUSSNER","gend":1,"currentgend":"","add":"1957 N JOANN","city":"WICHITA","state":"KS","zip":"67203","dob":"1948-06-10","age":"","mstatus":"","insh":"K44003958","cliId":"","pno":"3163027865","cno":"","email":"DJPREUSSNER@GMAIL.COM","ename":"","eno":"","pphy":"RANJINI MADHAVAN","ppno":"3166899111","pcpadd":"3311 E MURDOCK ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"37208-3079","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"007","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1578501474","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44003958","medicareid":"9UR1K61YD94","medicaidid":"9UR1K61YD94","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":["G4733","I480","J84112","E119","E782","K219","J42","I2510","J849","I10","F413","M810","G4734","G4730","G43709","K589","F909","R194","K635","K5732","D649","F900","F411","F331","S0181XD","S0003XD","S0003XA","W01198A","Z743","L659","G44229","R0609","R0902","S42402A","Z98890","Z9981","Z888","Z79899","I4891","E785","R42"],"date":["2026-04-15","2025-10-21","2026-06-09","2026-04-15","2024-04-04","2026-06-09","2025-04-02","2024-05-13","2024-05-13","2026-04-24","2026-06-09","2026-06-09","2026-06-09","2025-03-20","2026-02-26","2025-07-15","2026-02-26","2025-09-12","2026-02-26","2025-09-12","2026-06-09","2026-04-21","2026-04-21","2025-10-28","2025-12-18","2025-12-18","2025-12-03","2025-12-03","2025-12-03","2025-03-20","2025-03-20","2025-03-20","2026-02-26","2026-04-13","2026-04-15","2026-04-15","2026-04-15","2026-04-15","2026-04-24","2026-04-24","2026-04-24"],"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":[["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","ONDANSETRON HYDROCHLORIDE","4 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","ALENDRONATE SODIUM","70 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","100 MG","","Select","Select",""],["","","VERAPAMIL HYDROCHLORIDE ER","180 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","20 MG","","Select","Select",""],["","","MIRTAZAPINE","7.5 MG","","Select","Select",""],["","","VERAPAMIL HYDROCHLORIDE SR","120 MG","","Select","Select",""],["","","CLONIDINE HYDROCHLORIDE","0.1 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","DEXMETHYLPHENIDATE HCL","5 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","PIRFENIDONE","801 MG","","Select","Select",""],["","","DEXMETHYLPHENIDATE HYDROCHLORIDE","2.5 MG","","Select","Select",""],["","","CLONIDINE HYDROCHLORIDE ER","0.1 MG","","Select","Select",""],["","","LACTULOSE","10 GM","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","IBUPROFEN","800 MG","","Select","Select",""],["","","VERAPAMIL HCL ER","180 MG","","Select","Select",""],["","","Clonidine Tab","0.1 MG","","Select","Select",""],["","","Lactulose Sol","10 GM","","Select","Select",""],["","","Gavilyte-C Sol","","","Select","Select",""],["","","Verapamil Tab","180 MG","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Furosemide Tab","20 MG","","Select","Select",""],["","","Ibuprofen Tab","800 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Dexmethylph Tab","5 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Escitalopram Tab","20 MG","","Select","Select",""],["","","Sumatriptan Tab","100 MG","","Select","Select",""],["","","Pirfenidone Tab","801 MG","","Select","Select",""],["","","Alendronate Tab","70 MG","","Select","Select",""],["","","Atorvastatin 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":""}]}]}