{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBRA N MEILI","gend":1,"currentgend":"","add":"8835 S 103RD ST W","city":"CLEARWATER","state":"KS","zip":"67026","age":"","mstatus":"","insh":"K44005579","cliId":"","pno":"3166197130","cno":"","email":"dmeili@sktc.net","ename":"","eno":"","pphy":"JEFFREY REISWIG","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":"8835 S 103RD ST W","madd2":"","madd3":"","mcity":"CLEARWATER","mstate":"KS","mzip":"67026","pcpfaxno":"","pcpnpi":"1386752434","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44005579","medicareid":"6EN4E99PA89","medicaidid":"6EN4E99PA89","pcpFlag":"","dob":"1957-12-28"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D122","K648","Z86010","D120","K635","G4733","S52022A","S0990XA","V182XXA","Y92410","G8918","V199XXA","M79652","S59802A","S79822A","V180XXA","Y9355","Y92828","M779","L720","L570","M129","Z1211","W5501XA","Y92018","N816","N952","K529","Z87440","N898","G40909","K580","R5381","E785","S51812A","S80211A","S60811A","Z79899","H52223","H524","H2511","H43813","H5203","N390","H0102B"],"date":["2024-01-16","2024-07-09","2024-01-16","2024-01-16","2024-01-16","2024-07-09","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-18","2024-04-29","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-07-03","2024-07-29","2024-07-29","2024-08-12","2024-01-16","2024-09-29","2024-09-29","2024-12-03","2024-12-03","2024-12-03","2024-12-03","2024-12-03","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2024-04-19","2024-04-19","2024-04-19","2024-04-19","2025-06-27","2025-06-27","2025-06-27","2025-06-27","2025-06-27","2025-08-29","2026-03-09"],"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":[["","","MELOXICAM","7.5 MG","","Select","Select",""],["","","HYDROCORTISONE","2.50%","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","PHENYTOIN SODIUM EXTENDED","100 MG","","Select","Select",""],["","","PROPRANOLOL HYDROCHLORIDE ER","160 MG","","Select","Select",""],["","","PHENOBARBITAL","32.4 MG","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE","100 MG","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","FLUCELVAX 2024-2025","","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","PROPRANOLOL HCL ER","160 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":""}]}]}