{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BAMBI L WOLFORD","gend":1,"currentgend":"","add":"1418 SW Harp Place","city":"Topeka","state":"KS","zip":"66611","age":"","mstatus":"","insh":"K44007777","cliId":"","pno":"7858171182","cno":"","email":"tlwolford72@gmail.com","ename":"","eno":"","pphy":"RAAZIA AFTAB","ppno":"7852324248","pcpadd":"2641 SW WANAMAKER RD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"66606-1663","pcpcounty":"","pcpid":"","pcpname":"TOPEKA PHYSICIAN GROUP LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"7853792457","pcpnpi":"1629554696","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007777","medicareid":"8R96N89HN88","medicaidid":"8R96N89HN88","pcpFlag":"","dob":"1956-07-08"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["M51360","M25561","K5909","M7061","M25562","G8929","G2581","G4733","E611","E559","M797","E782","F418","M47817","Z1231","Z780","M8589","Z1211","G4700","Z79891","Z79899","M810","R92323","G4710","I10","J101","J14","E7800","E669","J45909","N6311","R0602","I517","R918","R110","R7989","I509","E871","R748","R062","R1013","H2513","H35363","Z20822","Z87891","K219","K5900","M7062","M4727","N3281","F331","M1991","I350","M47819","M79604","M79605","M25512","M5450"],"date":["2025-10-06","2025-10-06","2025-10-06","2026-06-01","2025-10-06","2025-10-06","2026-03-30","2025-07-16","2025-10-23","2025-10-23","2026-03-30","2026-03-30","2025-08-22","2025-08-22","2025-10-07","2025-10-07","2025-08-22","2026-03-30","2025-08-18","2025-10-06","2025-10-06","2025-10-07","2025-10-07","2025-12-16","2026-03-30","2025-10-23","2025-10-23","2025-06-12","2025-05-22","2025-06-12","2025-01-13","2025-02-23","2025-03-28","2025-02-26","2025-02-27","2025-02-26","2025-02-26","2025-03-11","2025-03-11","2026-03-30","2025-02-27","2025-04-22","2025-04-22","2025-02-23","2025-02-27","2025-02-27","2025-02-27","2026-06-01","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-06-01","2026-06-01","2026-06-01","2026-06-01","2026-06-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","5 MG","","Select","Select",""],["","","FLUOXETINE HYDROCHLORIDE","40 MG","","Select","Select",""],["","","DILT-XR","240 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","150 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","50 MG","","Select","Select",""],["","","TRIAMTERENE\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","75 MG","","Select","Select",""],["","","ROPINIROLE HYDROCHLORIDE","0.5 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE\/SALMETEROL","","","Select","Select",""],["","","OFLOXACIN","0.30%","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","0.50%","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SHINGRIX","50\/0.5 ML","","Select","Select",""],["","","PRAMIPEXOLE DIHYDROCHLORIDE","0.25 MG","","Select","Select",""],["","","Fluoxetine Cap","40 MG","","Select","Select",""],["","","Pramipexole Tab","0.25 MG","","Select","Select",""],["","","Losartan Pot Tab","50 MG","","Select","Select",""],["","","Oseltamivir Cap","75 MG","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Ketorolac Sol 0.5%","","","Select","Select",""],["","","Ketorolac Sol 0.5% Op","","","Select","Select",""],["","","Ofloxacin Dro 0.3% Op","","","Select","Select",""],["","","Oxybutynin Tab","5 MG","","Select","Select",""],["","","Prednisolone Sus 1% Op","","","Select","Select",""],["","","Trazodone Tab","100 MG","","Select","Select",""],["","","Triamt\/Hctz Cap 37.5-25","","","Select","Select",""],["","","Oxycod\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Shingrix Inj","50\/0.5 ML","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Ropinirole Tab","0.5 MG","","Select","Select",""],["","","Dilt-Xr Cap","240 MG","","Select","Select",""],["","","Flutic\/Salme Aer 250\/50","","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Cyclobenzapr Tab","10 MG","","Select","Select",""],["","","Bupropion Tab","150 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","Select","Select",""],["","","Omeprazole Cap","40 MG","","Select","Select",""],["","","Rosuvastatin 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":""}]}]}