{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT J HOLT","gend":0,"currentgend":"","add":"11711 W ROLLING HILLS DR","city":"WICHITA","state":"KS","zip":"67212","age":"","mstatus":"","insh":"K44008317","cliId":"","pno":"3162090455","cno":"","email":"","ename":"","eno":"","pphy":"EMMA WINGERT","ppno":"3163505455","pcpadd":"3161 N WEBB RD","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67226-8105","pcpcounty":"","pcpid":"","pcpname":"KANSAS DIABETES AND ENDOCRINOLOGY","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1235874728","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008317","medicareid":"8AK1GD9QM26","medicaidid":"8AK1GD9QM26","pcpFlag":"","dob":"1942-05-25"},{"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":["E782","N189","H04123","E113292","Z794","H3562","H02831","H02834","N184","R8290","E875","Z961","E785","I10","I350","N2581","I129","E1121","N200","E8722","M129","E790","E1122","M2041","M2042","E119","R262","M79674","M79675","E1165","B351","H1189","I739","Z955","Z951"],"date":["2026-06-16","2026-06-16","2026-01-15","2026-01-15","2026-04-21","2026-01-15","2026-01-15","2026-03-17","2026-03-09","2026-03-09","2026-03-23","2026-03-17","2026-04-21","2026-03-23","2026-04-21","2026-03-23","2026-04-21","2026-03-23","2026-03-23","2026-03-23","2026-03-23","2026-03-23","2026-04-21","2025-01-07","2025-01-07","2025-01-07","2025-06-10","2025-06-10","2025-06-10","2025-06-16","2025-06-10","2026-03-17","2026-04-21","2026-04-21","2026-04-21"],"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":[["","","JARDIANCE","10 MG","","Select","Select",""],["","","EZETIMIBE","10 MG","","Select","Select",""],["","","CALCITRIOL","0.25 MCG","","Select","Select",""],["","","RELION PEN NEEDLES 32G X 4MM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","HYDRALAZINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","BUMETANIDE","2 MG","","Select","Select",""],["","","CARVEDILOL","25 MG","","Select","Select",""],["","","VELTASSA","8.4 GM","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","TOUJEO MAX SOLOSTAR","","","Select","Select",""],["","","CLONIDINE","","","Select","Select",""],["","","HUMALOG KWIKPEN","","","Select","Select",""],["","","ONETOUCH VERIO REFLECT","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIPS","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCETS FINE 30G","30 G","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","ERYTHROMYCIN","0.50%","","Select","Select",""],["","","Humalog Kwik Inj 200\/Ml","","","Select","Select",""],["","","Relion Pen Mis 32Gx4Mm","","","Select","Select",""],["","","Carvedilol Tab","25 MG","","Select","Select",""],["","","Onetouch Del Mis Plus","30 G","","Select","Select",""],["","","Ezetimibe Tab","10 MG","","Select","Select",""],["","","Onetouch Tes Verio","","","Select","Select",""],["","","Bumetanide Tab","2 MG","","Select","Select",""],["","","Jardiance Tab","10 MG","","Select","Select",""],["","","Calcitriol Cap","0.25 MCG","","Select","Select",""],["","","Clonidine Dis 0.1\/24Hr","","","Select","Select",""],["","","Toujeo Max Inj 300\/Ml","","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Allopurinol Tab","300 MG","","Select","Select",""],["","","Veltassa Pow","8.4 GM","","Select","Select",""],["","","Atorvastatin Tab","40 MG","","Select","Select",""],["","","Onetouch Kit Verio Re","","","Select","Select",""],["","","Hydralazine Tab","100 MG","","Select","Select",""],["","","Amlodipine Tab","10 MG","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","Select","Select",""],["","","Meloxicam Tab","15 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":""}]}]}