{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY E DICK","gend":1,"currentgend":"","add":"13906 W Westport Ct","city":"Wichita","state":"KS","zip":"67235","age":"","mstatus":"","insh":"K44008065","cliId":"","pno":"3162151895","cno":"","email":"wingfieldkyle@hotmail.com","ename":"","eno":"","pphy":"JIHANE SFEIR","ppno":"3166512250","pcpadd":"818 N CARRIAGE PKWY","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67208-4500","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1215236815","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008065","medicareid":"8NE8XG7TV50","medicaidid":"8NE8XG7TV50","pcpFlag":"","dob":"1938-03-28"},{"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":["H25811","I480","H25812","I4589","I10","E785","R7303","E7800","N1830","M810","Z0289","E039","Z950","I442","I429","Z7901","S0990XA","R1020","R443","Z7189","Z789","I739","N179","Z780","M48061","I129","E1122","E1142","E1151","M5442","Z881","N3946","G5792","M4310","M4726","D539","Z7983","Z79891","Z7984","Z853","Z87440"],"date":["2025-06-25","2026-05-13","2025-08-26","2026-03-26","2026-03-26","2026-03-26","2026-03-13","2026-05-13","2026-05-13","2026-05-13","2026-03-13","2026-05-13","2026-05-13","2025-06-03","2026-05-13","2026-05-13","2026-02-07","2026-02-07","2026-02-07","2026-03-13","2026-03-13","2026-03-13","2026-05-13","2026-03-30","2026-05-13","2026-05-13","2026-05-13","2026-05-13","2026-05-13","2026-06-16","2026-02-07","2026-05-13","2026-05-13","2026-05-13","2026-05-13","2026-05-13","2026-05-13","2026-05-13","2026-05-13","2026-05-13","2026-05-13"],"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":[["","","DULOXETINE HYDROCHLORIDE","60 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","10 MG","","Select","Select",""],["","","ENTRESTO","51 MG","","Select","Select",""],["","","JARDIANCE","10 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","88 MCG","","Select","Select",""],["","","ELIQUIS","2.5 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","ALENDRONATE SODIUM","70 MG","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","51 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","60 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","0.50%","","Select","Select",""],["","","TOBRAMYCIN","0.30%","","Select","Select",""],["","","TOBRAMYCIN SULFATE","0.30%","","Select","Select",""],["","","Levothyroxin Tab","88 MCG","","Select","Select",""],["","","Eliquis Tab","2.5 MG","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Ketorolac Sol 0.5% Op","","","Select","Select",""],["","","Furosemide Tab","20 MG","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Duloxetine Cap","60 MG","","Select","Select",""],["","","Prednisolone Sus 1% Op","","","Select","Select",""],["","","Oxybutynin Tab","10 MG","","Select","Select",""],["","","Amoxicillin Tab","500 MG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Jardiance Tab","10 MG","","Select","Select",""],["","","Metoprol Suc Tab","50 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Entresto Tab 49-51Mg","","","Select","Select",""],["","","Sacub\/Valsar Tab 49-51Mg","","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Tobramycin Sol 0.3% Op","","","Select","Select",""],["","","Alendronate Tab","70 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":""}]}]}