{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KHAMFANG VICHITH","gend":0,"currentgend":"","add":"8911 E Bluestem St","city":"Wichita","state":"KS","zip":"67207","dob":"1949-04-07","age":"","mstatus":"","insh":"K44006462","cliId":"","pno":"3169936711","cno":"","email":"khamfang.health@outlook.com","ename":"","eno":"","pphy":"TIFFANY LIEURANCE","ppno":"3168585800","pcpadd":"800 N CARRIAGE PKWY","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67210-4508","pcpcounty":"","pcpid":"","pcpname":"WICHITA FAMILY MEDICINE SPECIALISTS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1790927549","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44006462","medicareid":"2EP6MR3JV65","medicaidid":"2EP6MR3JV65","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":["Z8619","Z0189","I10","Z5111","Z5112","R110","E860","C7951","H43811","H40011","D6481","Z79899","C118","N1831","R319","L989","R3129","H527","I129","N400","N281","H903","Z85818","Z789","E785","N200","Z125","I2720","R001","N189","Z8739","M549","E039","C801","R112","I950","R0600","M47814","H748X3","G9389","M898X2","Z23","R399","C119","C787","R3915","R1011","D490"],"date":["2025-08-04","2024-01-03","2026-03-30","2026-06-04","2025-09-15","2024-04-01","2026-05-14","2026-05-14","2024-02-29","2024-10-30","2024-02-22","2025-05-12","2025-04-09","2026-02-23","2024-04-12","2024-04-19","2024-08-14","2024-04-29","2026-03-30","2026-03-30","2026-03-30","2024-05-06","2024-05-06","2025-06-12","2026-02-23","2026-03-30","2026-03-27","2025-08-07","2025-08-07","2025-08-07","2026-02-23","2025-08-26","2025-10-15","2025-10-09","2026-04-30","2025-01-07","2025-01-07","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2026-02-23","2026-03-30","2026-03-30","2026-03-30","2026-05-11","2026-05-11","2026-05-11"],"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":[["","","GABAPENTIN","100 MG","","Select","Select",""],["","","MIDODRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","ONDANSETRON ODT","8 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","SIMVASTATIN","40 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","25 MCG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","Midodrine Tab","10 MG","","Select","Select",""],["","","Ondansetron Tab","8 MG","","Select","Select",""],["","","Baclofen Tab","10 MG","","Select","Select",""],["","","Gabapentin Cap","100 MG","","Select","Select",""],["","","Simvastatin Tab","40 MG","","Select","Select",""],["","","Metoprol Suc Tab","50 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Levothyroxin Tab","25 MCG","","Select","Select",""],["","","Tamsulosin Cap","0.4 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":""}]}]}