{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESLEY J HONEY","gend":1,"currentgend":"","add":"9545 E Hwy 42","city":"Spivey","state":"KS","zip":"67142","age":"","mstatus":"","insh":"K44008085","cliId":"","pno":"3162152965","cno":"","email":"joeysmom55@gmail.com","ename":"","eno":"","pphy":"MELISSA BAILEY","ppno":"3162198299","pcpadd":"1001 N MINNEAPOLIS ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67226-4104","pcpcounty":"","pcpid":"","pcpname":"UKSM-WICHITA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9545 E STATE ROAD 42","madd2":"","madd3":"","mcity":"RAGO","mstate":"KS","mzip":"67142","pcpfaxno":"","pcpnpi":"1699217034","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008085","medicareid":"4RX8U76MP40","medicaidid":"4RX8U76MP40","pcpFlag":"","dob":"1956-02-02"},{"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":["M25552","M79652","M6281","R262","M25551","E785","E063","I10","R718","R7301","R7989","I4892","I110","I5032","N951","R61","H353131","H524","M79605","Z96652","M5416","M5459","Z0183","R001","R5383","R42","Z7901","K649","I509","E039","I4891","Z9089","Z87891","B372","T887XXA","Z7982","Z7902","Z955"],"date":["2025-08-22","2025-08-22","2025-08-22","2025-08-22","2025-08-22","2026-06-04","2026-03-26","2026-06-04","2025-10-16","2026-03-26","2025-11-21","2025-03-11","2025-03-11","2025-03-11","2025-03-18","2025-05-14","2026-04-14","2026-04-14","2025-05-14","2025-04-16","2025-04-21","2025-04-21","2026-02-26","2026-05-12","2026-05-12","2026-05-12","2026-06-04","2026-06-04","2026-06-04","2026-06-04","2026-06-04","2026-06-04","2026-06-04","2026-03-31","2026-04-08","2026-04-04","2026-04-04","2026-04-04"],"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":[["","","PROGESTERONE","200 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","FLECAINIDE ACETATE","50 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","112 MCG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","5 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","DOTTI","0.075 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","ECONAZOLE NITRATE","1%","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ESTRADIOL","0.05 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","AMIODARONE HYDROCHLORIDE","400 MG","","Select","Select",""],["","","Flecainide Tab","50 MG","","Select","Select",""],["","","Levothyroxin Tab","100 MCG","","Select","Select",""],["","","Progesterone Cap","100 MG","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Dotti Dis","0.075 MG","","Select","Select",""],["","","Pot Chloride Tab","20 MEQ","","Select","Select",""],["","","Pot Cl Micro Tab","20 MEQ","","Select","Select",""],["","","Estradiol Dis","0.05 MG","","Select","Select",""],["","","Furosemide Tab","40 MG","","Select","Select",""],["","","Losartan Pot Tab","100 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Rosuvastatin Tab","5 MG","","Select","Select",""],["","","Amiodarone Tab","400 MG","","Select","Select",""],["","","Amlodipine Tab","5 MG","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","Select","Select",""],["","","Eliquis Tab","5 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":""}]}]}