{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAYMOND M BROWN","gend":0,"currentgend":"","add":"207 PINE ST","city":"WAMEGO","state":"KS","zip":"66547","dob":"1978-05-06","age":"","mstatus":"","insh":"K44007388","cliId":"","pno":"3166176492","cno":"","email":"","ename":"","eno":"","pphy":"PATRICIA GUTOWSKI","ppno":"7855659500","pcpadd":"1133 SW TOPEKA BLVD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66502-2770","pcpcounty":"","pcpid":"","pcpname":"MY KIDNEY CENTER","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"207 PINE ST","madd2":"","madd3":"","mcity":"WAMEGO","mstate":"KS","mzip":"66547","pcpfaxno":"","pcpnpi":"1720610066","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007388","medicareid":"1YW4QE9MU81","medicaidid":"1YW4QE9MU81","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0602","E119","Z794","I10","E785","I2510","Z87891","G4710","E1142","F419","J441","R0609","F515","F4310","F411","G4700","J449","E039","E6601","Z8739","R0789","R600","E1165","R1312","N189","R0600","M546","G4733","M5459","F410","Z609","N179","I959","K219","F32A","E1122","R531","N178","N182","I9589","E6609","Z6843","R1084","K921","R1310","E669","F909","M792","M51362","J309","R935","E875","R109","D509","E038","E876","K641","R197","H21543","H2513","H5212","H52221","H524","R1319","K222","D123","T18128A","R42","R059","G4730","M48061","Z6842","H43393","H52223","J986","R609","E8342","E559","R891","R000","Z7984","I129","E860","E11649","M549","E1121","Z79899","Z79890","Z9989","G8929","Z7985","Z9861","M51369","M47817","M51379","M4807","F17290","F331","F5105","Z631","Z9181","Z7902","F4312","M62838","H8113","M79672","M722","M76822","M76821","E1159","G6289","M2141","M2142","L408","L84","I739","E66813","Z6844","K2289","K3189","F339","F509","Z01818","T380X5A","Z8679","R200","Z8659","E88810","R29898","R944","R791","R918","R471","G510","R29810","E1140","R2689","R296","I951","Z9641","R202"],"date":["2026-05-11","2026-03-10","2026-06-10","2026-06-10","2026-06-10","2026-05-13","2025-06-29","2024-12-03","2025-07-10","2026-05-13","2024-11-13","2025-08-17","2025-11-14","2026-05-13","2026-03-10","2026-04-15","2024-11-13","2026-05-13","2026-05-13","2026-04-23","2026-04-06","2026-05-12","2026-06-10","2026-05-12","2025-08-17","2025-06-29","2025-06-29","2026-04-23","2025-06-27","2026-05-04","2026-05-04","2025-09-16","2025-08-16","2026-06-10","2026-05-12","2026-05-13","2026-05-13","2025-08-13","2026-05-13","2026-02-11","2025-10-08","2026-05-12","2025-08-16","2025-09-25","2025-09-25","2026-03-10","2026-05-13","2025-07-15","2025-08-26","2025-08-26","2025-08-17","2025-08-17","2025-08-15","2025-01-04","2025-01-03","2025-04-18","2025-09-25","2025-09-25","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2026-06-09","2025-09-25","2025-09-25","2025-09-25","2025-06-26","2026-05-06","2025-06-26","2025-11-11","2025-10-08","2025-01-27","2025-01-27","2025-04-24","2025-06-10","2025-04-18","2026-06-04","2025-04-18","2025-06-06","2025-06-27","2026-05-12","2025-07-09","2025-06-27","2025-07-09","2025-06-27","2025-09-25","2025-07-09","2025-06-27","2026-05-13","2025-07-09","2025-07-09","2025-09-08","2025-09-08","2025-09-08","2025-09-08","2026-05-11","2026-05-04","2026-01-21","2026-05-04","2026-02-11","2026-02-11","2026-02-11","2026-03-10","2026-03-10","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-05-13","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-06-10","2026-04-02","2026-04-30","2026-04-30","2026-04-15","2026-04-15","2026-04-15","2026-05-13","2026-05-13","2026-05-11","2026-05-13","2026-04-23","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-12","2026-06-04","2026-05-12","2026-05-12","2026-05-12","2026-05-12","2026-05-12","2026-05-12","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":[["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","CONTOUR NEXT EZ BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","METOPROLOL TARTRATE","25 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","110 MCG","","Select","Select",""],["","","AMPHETAMINE\/DEXTROAMPHETAMINE","30 MG","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","KETOCONAZOLE","2%","","Select","Select",""],["","","SYNTHROID","125 MCG","","Select","Select",""],["","","BUMETANIDE","1 MG","","Select","Select",""],["","","OZEMPIC","8 MG","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","DIAZEPAM","2 MG","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000 MG","","Select","Select",""],["","","PRAZOSIN HYDROCHLORIDE","5 MG","","Select","Select",""],["","","HUMULIN R U-500 KWIKPEN","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","FENOFIBRATE","160 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","HUMULIN R U-500 (CONCENTRATED)","","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","150 MG","","Select","Select",""],["","","FLUDROCORTISONE ACETATE","0.1 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","PENTIPS GENERIC PEN NEEDLES 32GX4MM","","","Select","Select",""],["","","OMNIPOD 5 DEXCOM G7G6 PODS (GEN 5)","","","Select","Select",""],["","","OMNIPOD 5 DEXCOM G7G6 INTRO KIT (GEN 5)","","","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","150 MG","","Select","Select",""],["","","ULTICARE INSULIN SYRINGE ULTRAFINE U-100\/1ML\/31G X 5\/16\"","1 ML","","Select","Select",""],["","","HUMALOG KWIKPEN","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","EUTHYROX","25 MCG","","Select","Select",""],["","","POTASSIUM CHLORIDE","10%","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","200 MCG","","Select","Select",""],["","","LANTUS","","","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE","","","Select","Select",""],["","","DEXCOM G7 15 DAY SENSOR","","","Select","Select",""],["","","ARNUITY ELLIPTA","100 MCG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","SURE COMFORT PEN NEEDLES 32GX5\/32\"","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","0.05%","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","50 MG","","Select","Select",""],["","","MIDODRINE HYDROCHLORIDE","2.5 MG","","Select","Select",""],["","","HYDROXYZINE HCL","50 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","VALACYCLOVIR HYDROCHLORIDE","1 GM","","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":""}]}]}