{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICAELA E DALE","gend":1,"currentgend":"","add":"116 W Pawnee Ave","city":"Wichita","state":"KS","zip":"67213","age":"","mstatus":"","insh":"K44008949","cliId":"","pno":"9037470869","cno":"","email":"","ename":"","eno":"","pphy":"KELLI RICE","ppno":"3166899111","pcpadd":"848 N SAINT FRANCIS ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"37208-3079","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"116 W PAWNEE AVE","madd2":"","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"672134815","pcpfaxno":"","pcpnpi":"1881144376","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008949","medicareid":"6UG2AP1DF88","medicaidid":"6UG2AP1DF88","pcpFlag":"","dob":"1993-05-24"},{"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":["Z975","R809","R1013","Z20822","H543","Z79899","S299XXA","S22070A","S199XXA","S7002XA","W109XXA","R112","R824","Z753","Z59819","Z59869","G43909","Z3202","S0990XA"],"date":["2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-03-10","2025-03-10","2025-04-12","2025-04-12","2025-04-12","2025-04-12","2025-04-12","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-04-12"],"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":[["","","TIZANIDINE HYDROCHLORIDE","4 MG","","Select","Select",""],["","","LEVETIRACETAM","750 MG","","Select","Select",""],["","","GABAPENTIN","600 MG","","Select","Select",""],["","","OMEPRAZOLE DR","20 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","20 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","NAYZILAM","5 MG","","Select","Select",""],["","","MELOXICAM","7.5 MG","","Select","Select",""],["","","METHOCARBAMOL","750 MG","","Select","Select",""],["","","IBUPROFEN","600 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","Ibuprofen Tab","600 MG","","Select","Select",""],["","","Levetiraceta Tab","750 MG","","Select","Select",""],["","","Tizanidine Tab","4 MG","","Select","Select",""],["","","Trazodone Tab","100 MG","","Select","Select",""],["","","Ondansetron Tab","4 MG","","Select","Select",""],["","","Methocarbam Tab","750 MG","","Select","Select",""],["","","Metoprol Suc Tab","25 MG","","Select","Select",""],["","","Oxycodone Tab","5 MG","","Select","Select",""],["","","Nayzilam Spr","5 MG","","Select","Select",""],["","","Gabapentin Tab","600 MG","","Select","Select",""],["","","Escitalopram Tab","20 MG","","Select","Select",""],["","","Meloxicam Tab","7.5 MG","","Select","Select",""],["","","Omeprazole Cap","20 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":""}]}]}