{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JODY D WILSON","gend":1,"currentgend":"","add":"8000 S Santa Fe St","city":"Haysville","state":"KS","zip":"67060","dob":"1962-05-26","age":"","mstatus":"","insh":"K44006295","cliId":"","pno":"7853175407","cno":"","email":"","ename":"","eno":"","pphy":"NICHOLE RIDDEL","ppno":"3167219500","pcpadd":"8444 W 21ST ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67205-1752","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8000 S Santa Fe St","madd2":"","madd3":"","mcity":"Haysville","mstate":"KS","mzip":"67060","pcpfaxno":"","pcpnpi":"1134430853","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006295","medicareid":"3E98AX8KM56","medicaidid":"3E98AX8KM56","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":["Z13820","Z1239","I10","E7800","E162","D649","R7303","M85851","M85852","R7989","M2041","M19071","R52","Z806","K621","K2970","K3189","D509","K2930","Z86010","Z1211","D72820","M5030","M4326","R1310","H6991","H9201","J0100","K219","M2011","M216X1","M205X1","W19XXXA","F0781","D500","J342","J3089","H903","G4700","R413","Z1231","M12571","M25374","E669","Z6832","E785","K449","F32A","F419","Z888","N189","G3184","Z820","Z79899","J029","Z20822","G8929","F411","H9190","R531","M62830","L03113","N179","M549","R262","M4646","I129","Z881","Z9682","Z792","D72829","M5450","M546","Z96653","Z09","E611","E538","T85733D","B9561","E876","Z789","B9689","R197","N1831","D508","G894","M5489","G609","M62838","A4101","D518","D528","B370","B001","K649","R2689","Z8639","E7849","D6489","A4901","R748","I82B11","I82621","Z22322","R0602","R0609","R059","R634","Z8619","I82A11","I82611","I82B21","G9341","L0292","D539","B002","Z6831","Z9689","K5909","K581","E782","Z860100","Z9049","Z981","F39"],"date":["2024-01-17","2024-01-17","2026-05-07","2024-01-17","2024-01-17","2026-05-05","2024-01-18","2024-01-29","2024-01-29","2026-05-12","2025-05-06","2025-05-06","2026-06-02","2024-02-28","2024-03-14","2024-03-14","2024-03-14","2024-10-15","2024-03-14","2024-03-14","2024-03-14","2026-02-23","2024-05-03","2024-05-03","2024-05-03","2024-05-03","2024-05-21","2024-05-21","2026-05-12","2024-06-17","2024-06-28","2024-06-28","2024-07-09","2024-07-09","2025-08-18","2024-05-30","2024-07-22","2024-07-22","2024-07-26","2024-10-15","2024-01-29","2024-01-29","2024-06-28","2026-03-30","2024-06-28","2026-05-12","2024-06-28","2026-04-30","2026-04-30","2026-05-12","2026-05-14","2025-09-02","2025-09-02","2026-05-11","2025-02-06","2025-02-10","2026-04-24","2025-05-21","2026-05-12","2026-03-12","2026-03-11","2026-05-11","2026-06-02","2026-05-14","2026-05-12","2026-03-14","2026-05-14","2026-05-14","2026-05-14","2026-05-16","2026-03-30","2026-05-07","2026-03-19","2026-05-12","2026-05-05","2026-05-11","2026-05-11","2026-04-30","2026-05-14","2026-04-28","2026-05-11","2026-05-07","2026-05-07","2026-05-12","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-28","2026-04-13","2026-04-13","2026-04-13","2026-04-28","2026-04-28","2026-04-28","2026-04-07","2026-04-28","2026-04-03","2026-05-14","2026-05-14","2026-05-12","2026-05-14","2026-05-20","2026-05-20","2026-05-20","2026-05-20","2026-06-02","2026-06-02","2026-05-11","2026-05-11","2026-06-12","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-05-12","2026-03-30","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":[["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","BACLOFEN","20 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","BUSPIRONE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","AMITRIPTYLINE HYDROCHLORIDE","75 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","25 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE","60 MG","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","SPIKEVAX COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","30 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":""}]}]}