{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICKIE L MELTON","gend":1,"currentgend":"","add":"233 S Bonnie Brae St","city":"Wichita","state":"KS","zip":"67207","age":"","mstatus":"","insh":"K44008464","cliId":"","pno":"3167348193","cno":"","email":"vickiemelton22@icloud.com","ename":"","eno":"","pphy":"EMILY ODELL","ppno":"3167898222","pcpadd":"1640 E TALL TREE RD","pcpcity":"DERBY","pcpstate":"KS","pcpzip":"67037-2000","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":"1083095970","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008464","medicareid":"4E04V40XV95","medicaidid":"4E04V40XV95","pcpFlag":"","dob":"1948-01-22"},{"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":["R7989","I442","I2510","R011","I4891","R0609","Z950","I340","I351","I080","I2720","E785","J069","R748","R0982","J029","J392","R0602","J387","J300","J309","R102","Z955","B9789","Z1152"],"date":["2025-06-12","2025-05-08","2025-05-08","2025-05-08","2025-11-20","2025-02-18","2026-03-11","2025-11-20","2025-03-07","2025-03-07","2025-11-20","2025-01-21","2025-04-25","2025-04-25","2025-05-01","2025-05-01","2025-05-01","2025-04-25","2025-05-16","2025-05-16","2025-05-16","2025-06-23","2025-03-07","2026-01-02","2026-01-02"],"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":[["","","GABAPENTIN","100 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","80 MG","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","30 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","75 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","IPRATROPIUM BROMIDE","0.03%","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","VALACYCLOVIR HYDROCHLORIDE","500 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","Isosorb Mono Tab","30 MG","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Metoprol Tar Tab","75 MG","","Select","Select",""],["","","Ipratropium Spr 0.03%","","","Select","Select",""],["","","Metoprol Suc Tab","50 MG","","Select","Select",""],["","","Lisinopril Tab","20 MG","","Select","Select",""],["","","Gabapentin Cap","100 MG","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Atorvastatin Tab","80 MG","","Select","Select",""],["","","Valacyclovir Tab","500 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","Select","Select",""],["","","Azithromycin Tab","250 MG","","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":""}]}]}