{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ETHRA L LOVE","gend":1,"currentgend":"","add":"2615 N PERSHING ST","city":"WICHITA","state":"KS","zip":"67220","dob":"1967-10-16","age":"","mstatus":"","insh":"K44005612","cliId":"","pno":"3163128932","cno":"","email":"","ename":"","eno":"","pphy":"BRENDA ARCE","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":"006","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2615 N PERSHING ST","madd2":"","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"67220","pcpfaxno":"","pcpnpi":"1124889571","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44005612","medicareid":"9NV2RQ8FE70","medicaidid":"9NV2RQ8FE70","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N184","Z6843","Z713","G4733","E119","N189","E668","Z1331","I10","E669","I120","E6601","Z1589","L97512","M79674","Z794","Z789","E11628","I129","N1830","M1000","L02611","S91104A","M1009","H00011","D509","J0100","Z91040","H35033","H35411","R030","D609","D631","L89899","N179","R7303","X58XXXA","M7752","E1159","M79672","E1122","I1310","E66813","E11621","N185","L089","L97529","Z79899","Z888","Z9851","Z302","R42","M1030","M1990","F32A","M79673","S91309A","Z09"],"date":["2026-02-13","2026-06-08","2024-04-22","2024-07-16","2025-03-11","2024-06-26","2024-04-17","2024-04-17","2026-05-13","2026-02-13","2024-06-26","2026-06-08","2024-10-15","2025-02-11","2025-02-25","2026-05-20","2024-10-30","2024-11-14","2026-06-08","2026-06-08","2024-11-21","2026-05-11","2024-09-06","2025-03-11","2025-04-02","2026-01-25","2025-11-20","2026-01-23","2025-05-08","2025-05-08","2026-01-23","2026-01-26","2026-01-24","2026-01-25","2026-01-24","2026-01-25","2026-02-13","2026-01-23","2026-04-02","2026-05-13","2026-06-08","2026-03-03","2026-05-13","2026-05-20","2026-01-13","2026-01-12","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-06-08","2026-06-08","2026-06-08","2026-05-12","2026-05-12","2026-05-12"],"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":[["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","AMOXICILLIN","875 MG","","Select","Select",""],["","","CARVEDILOL","25 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","TORSEMIDE","10 MG","","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","300 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","NEOMYCIN\/POLYMYXIN\/DEXAMETHASONE","0.10%","","Select","Select",""],["","","OZEMPIC","2 MG","","Select","Select",""],["","","AMILORIDE HCL","5 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","25 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","HYDRALAZINE HYDROCHLORIDE","10 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":""}]}]}