{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES S ERICKSON","gend":0,"currentgend":"","add":"400 W CENTRAL AVE","city":"WICHITA","state":"KS","zip":"672034062","age":"","mstatus":"","insh":"K44008351","cliId":"","pno":"3166333811","cno":"","email":"","ename":"","eno":"","pphy":"DAVID KORTJE","ppno":"3165241613","pcpadd":"3133 S SENECA ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67217-3234","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDCENTERS PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT 1706","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1548279193","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008351","medicareid":"8FG3AE5XR77","medicaidid":"8FG3AE5XR77","pcpFlag":"","dob":"1957-07-05"},{"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":["I480","I38","I2510","I10","E785","E669","I509","G809","E6601","Z79899","Z719","I4819","E7849","I5020","I4891","H548","F17210","Z7901","Z955","I110","Z1331","Z125","Z9181","J449","Z6833"],"date":["2026-03-23","2026-03-23","2026-03-23","2026-03-23","2026-03-23","2026-03-23","2026-02-09","2026-02-09","2026-02-09","2025-09-22","2025-09-22","2025-07-09","2025-03-24","2025-03-24","2026-02-09","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2026-02-09","2026-02-09","2026-02-09","2026-02-09","2026-02-09","2026-02-09"],"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":[["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","AMIODARONE HYDROCHLORIDE","200 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","26 MG","","Select","Select",""],["","","ENTRESTO","26 MG","","Select","Select",""],["","","FARXIGA","10 MG","","Select","Select",""],["","","DIGOXIN","0.125 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","Farxiga Tab","10 MG","","Select","Select",""],["","","Entresto Tab 24-26Mg","","","Select","Select",""],["","","Sacub\/Valsar Tab 24-26Mg","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Furosemide Tab","20 MG","","Select","Select",""],["","","Metoprol Suc Tab","100 MG","","Select","Select",""],["","","Digoxin Tab","0.125 MG","","Select","Select",""],["","","Mnexspike Inj 2025-26","","","Select","Select",""],["","","Atorvastatin Tab","10 MG","","Select","Select",""],["","","Eliquis Tab","5 MG","","Select","Select",""],["","","Amiodarone Tab","200 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":""}]}]}