{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELORIS A MULL","gend":1,"currentgend":"","add":"3033 N TOPAZ CIR","city":"WICHITA","state":"KS","zip":"67205","dob":"1951-11-01","age":"","mstatus":"","insh":"K44007086","cliId":"","pno":"3162593551","cno":"","email":"","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":"006","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1386752434","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007086","medicareid":"1A30P58FG07","medicaidid":"1A30P58FG07","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":["H26492","R252","Z981","M542","R42","J309","I480","I10","M5116","R5383","E785","R0602","R739","D508","R82998","E039","N3000","R809","R319","N390","M5412","M5459","M5415","M5417","M4326","Z8679","M546","M4327"],"date":["2025-07-28","2026-04-29","2026-03-02","2026-04-29","2025-11-06","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-06-12","2025-06-12","2026-06-10","2026-06-10","2025-06-12","2026-04-29","2026-06-10","2026-06-10"],"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":[["","","ZOLPIDEM TARTRATE","10 MG","","Select","Select",""],["","","DICLOFENAC SODIUM DR","75 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","MECLIZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","75 MCG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","PREGABALIN","25 MG","","Select","Select",""],["","","Meclizine Tab","25 MG","","Select","Select",""],["","","Ciprofloxacn Tab","500 MG","","Select","Select",""],["","","Diclofenac Tab","75 MG","","Select","Select",""],["","","Metoprol Suc Tab","25 MG","","Select","Select",""],["","","Cyclobenzapr Tab","10 MG","","Select","Select",""],["","","Levothyroxin Tab","75 MCG","","Select","Select",""],["","","Prednisone Tab","10 MG","","Select","Select",""],["","","Zolpidem Tab","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":""}]}]}