{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EILEEN D KIEHL","gend":1,"currentgend":"","add":"5146 N BROOKSTONE ST","city":"BEL AIRE","state":"KS","zip":"67226","age":"","mstatus":"","insh":"K44005854","cliId":"","pno":"3166331939","cno":"","email":"kiehlintotoland@gmail.com","ename":"","eno":"","pphy":"JADEN HUTFLES","ppno":"3162198299","pcpadd":"10100 E SHANNON WOODS ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67226-4104","pcpcounty":"","pcpid":"","pcpname":"KANSAS JOINT & SPINE SPEC LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5146 N BROOKSTONE ST","madd2":"","madd3":"","mcity":"BEL AIRE","mstate":"KS","mzip":"67226","pcpfaxno":"","pcpnpi":"1467164350","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44005854","medicareid":"6YH5TW2KF59","medicaidid":"6YH5TW2KF59","pcpFlag":"","dob":"1957-03-05"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","Z6832","M48061","M5136","L578","L820","L538","Z789","R911","J302","G4733","I10","E242","Z01818","Z01811","Z01810","Z01812","D692","M4325","M5116","E249","E271","R7303","J45909","Z6837","Z7983","E876","E785","E669","Z7984","Z87891","G4730","Z98890","M51360","M961","J45991","Z23","M51362","L858","L821","L814","Z1283","R208","L570","M810","R635","H02834","Q670","D225","L918","Z6833","M8588","E2749","E119","Z981"],"date":["2024-03-05","2024-01-16","2025-10-31","2024-01-31","2026-04-01","2025-10-01","2025-10-01","2025-10-01","2026-06-15","2026-06-15","2025-10-31","2026-06-15","2026-06-15","2024-03-25","2024-03-25","2025-10-16","2024-03-25","2024-02-06","2024-01-15","2025-10-31","2024-04-19","2024-04-19","2025-09-30","2025-10-31","2024-04-19","2024-04-19","2024-04-19","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2024-04-19","2025-04-21","2025-08-04","2025-10-16","2026-06-15","2025-09-30","2025-09-17","2025-10-01","2026-04-01","2026-04-01","2026-04-01","2025-10-01","2026-04-01","2026-06-01","2026-05-26","2025-02-25","2025-02-25","2026-04-01","2025-03-28","2025-03-27","2025-03-13","2025-03-13","2025-10-31","2026-04-27"],"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":[["","","TYMLOS","","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","100 MG","","Select","Select",""],["","","MOUNJARO","5 MG","","Select","Select",""],["","","MONTELUKAST SODIUM","10 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 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":""}]}]}