{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUSSELL L MACK","gend":0,"currentgend":"","add":"3101 W DOUGLAS AVE","city":"WICHITA","state":"KS","zip":"67213","dob":"1957-10-15","age":"","mstatus":"","insh":"K44005527","cliId":"","pno":"3165184919","cno":"","email":"BIGMACK4@HOTMAIL.COM","ename":"","eno":"","pphy":"RICHA SHARMA","ppno":3166899111,"pcpadd":"3311 E MURDOCK ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"37208-3079","pcpcounty":"","pcpid":"","pcpname":"ASCENSION VIA CHRISTI PHYSICIAN GROUP","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1720574551","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44005527","medicareid":"2WE6M39TC73","medicaidid":"2WE6M39TC73","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":["N189","I10","I5030","E119","M7989","E7849","Z0000","E1122","N1832","E669","R9439","E782","Z794","N1830","I129","E6609","Z6841","M25511","B351","L84","Z6838","M25561","I6523","E66811","J811","Z98890","Z951","J9811","R410","I160","Z01810","J9600","R2689","M170","I7091","I2510","I130","I5032","E875","F32A","G4700","N179","I5033","J951","R571","J95822","F05","D696","D62","E1165","E785","Z7982","Z7985","Z79899","D72829","K219","E871","Z6836","Z7409","R5381","R531","F418","R0689","Z7901","Z6839","Z6835","S81801A","M159","L97812"],"date":["2026-01-16","2026-06-01","2026-06-01","2026-06-01","2026-01-02","2025-12-05","2026-06-01","2026-02-26","2026-02-26","2026-01-23","2025-07-22","2026-06-01","2026-02-25","2026-06-01","2026-02-26","2026-02-26","2024-03-21","2024-07-10","2026-06-03","2026-06-03","2025-12-08","2026-03-24","2025-12-02","2025-12-01","2025-12-03","2025-12-09","2026-03-24","2025-12-07","2025-12-07","2025-12-11","2025-12-11","2025-12-07","2025-12-16","2026-02-19","2026-06-03","2026-06-01","2026-01-16","2025-12-18","2025-12-18","2026-01-16","2026-01-16","2025-12-11","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-11","2025-12-08","2026-01-16","2026-01-16","2025-12-08","2025-12-11","2025-12-08","2025-12-08","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2026-02-26","2026-03-24","2026-03-24","2026-06-01","2026-03-05"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","OZEMPIC","8 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","BUMETANIDE","0.5 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","HUMALOG","","","Select","Select",""],["","","HYDRALAZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","INSULIN DEGLUDEC FLEXTOUCH","","","Select","Select",""],["","","TRESIBA FLEXTOUCH","","","Select","Select",""],["","","CARVEDILOL","25 MG","","Select","Select",""],["","","HUMALOG KWIKPEN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS\/SENSOR\/GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","FARXIGA","10 MG","","Select","Select",""],["","","GENTAMICIN SULFATE","0.10%","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","CEPHALEXIN","250 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","BASAGLAR KWIKPEN","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","JARDIANCE","25 MG","","Select","Select",""],["","","EMBECTA PEN NEEDLE\/NANO 2ND GEN\/32G X 4MM","","","Select","Select",""],["","","DROPLET INSULIN SYRINGE\/U-100\/0.5ML\/31G X 15\/64\"","0.5\/31 G","","Select","Select",""],["","","FREESTYLE LIBRE 3\/SENSOR\/GLUCOSE MONITORING SYSTEM","","","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":""}]}]}