{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAYNE M OTIS","gend":1,"currentgend":"","add":"4825 E Pembrook Ct","city":"Wichita","state":"KS","zip":"67220","dob":"1955-03-11","age":"","mstatus":"","insh":"K44008270","cliId":"","pno":"3164481284","cno":"","email":"whiteswan713@gmail.com","ename":"","eno":"","pphy":"GERALD NIERNBERGER","ppno":"3166094501","pcpadd":"14700 W SAINT TERESA ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67206-2900","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":"1417986894","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008270","medicareid":"3FE1M40AX29","medicaidid":"3FE1M40AX29","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":["M5416","M47816","H47021","H26493","J309","I10","M5450","R531","R1013","R079","E782","I447","E1165","E7800","M51369","E119","Z7984","H04123","H524","M549","H401231","N6021","R92313","R921","R92311","H43813"],"date":["2025-07-01","2025-11-20","2026-03-02","2026-03-02","2026-01-20","2026-04-20","2026-04-20","2025-06-27","2025-06-27","2025-01-15","2026-01-21","2026-01-21","2025-01-27","2026-04-20","2025-02-06","2026-06-02","2026-06-02","2026-06-02","2025-03-14","2026-01-20","2025-05-02","2026-05-01","2026-04-03","2026-04-03","2026-04-21","2026-06-02"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","CAPVAXIVE","0.5 ML","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","TIMOLOL MALEATE","0.50%","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","CEFPROZIL","500 MG","","Select","Select",""],["","","LATANOPROST","0.01%","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","DEXCOM G7 15 DAY SENSOR","","","Select","Select",""],["","","AZELASTINE HYDROCHLORIDE","0.10%","","Select","Select",""],["","","TOBRAMYCIN\/DEXAMETHASONE","0.10%","","Select","Select",""],["","","COMIRNATY 2024-25","","","Select","Select",""],["","","OZEMPIC","8 MG","","Select","Select",""],["","","Timolol Mal Sol 0.5% Op","","","Select","Select",""],["","","Cefprozil Tab","500 MG","","Select","Select",""],["","","Comirnaty Inj 2024-25","","","Select","Select",""],["","","Comirnaty Inj 30\/.3Ml","","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Latanoprost Sol 0.005%","","","Select","Select",""],["","","Ondansetron Tab","4 MG","","Select","Select",""],["","","Famotidine Tab","40 MG","","Select","Select",""],["","","Ozempic Inj","8 MG","","Select","Select",""],["","","Capvaxive Inj","0.5 ML","","Select","Select",""],["","","Atorvastatin Tab","20 MG","","Select","Select",""],["","","Azelastine Spr 0.1%","","","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":""}]}]}