{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORI A LANDES","gend":1,"currentgend":"","add":"8236 E Morningside st","city":"Wichita","state":"KS","zip":"67207","dob":"1958-12-11","age":"","mstatus":"","insh":"K44008962","cliId":"","pno":"3165587583","cno":"","email":"","ename":"","eno":"","pphy":"EDWARD WEIPPERT","ppno":"3167214544","pcpadd":"8200 W CENTRAL AVE","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67212-3661","pcpcounty":"","pcpid":"","pcpname":"WEST WICHITA FAMILY PHYSICIANS","plan":"BCBSKS","program":"Medicare","lob":"006","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8236 E Morningside st","madd2":"","madd3":"","mcity":"Wichita","mstate":"KS","mzip":"67207","pcpfaxno":"","pcpnpi":"1992813950","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008962","medicareid":"1RK4NN8HD09","medicaidid":"1RK4NN8HD09","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":["R0902","J449","I2510","E039","I5040","J811","R7989","I10","R0609","J411","E782","N390","Z1231","R0602","J9601","J439","I5030","E785","F17200","Z955","Z7982","Z7902","Z79890","Z79899","R8271","B9620"],"date":["2025-08-15","2026-01-19","2026-01-19","2026-01-19","2026-01-19","2025-08-06","2025-08-06","2025-08-06","2025-08-04","2025-08-04","2026-01-19","2026-01-19","2025-01-17","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2026-01-19","2026-01-19"],"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":[["","","ATORVASTATIN CALCIUM","80 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","LISINOPRIL","2.5 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","100 MCG","","Select","Select",""],["","","METOPROLOL TARTRATE","25 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","220 MCG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Levothyroxin Tab","88 MCG","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Fluticas Hfa Aer","220 MCG","","Select","Select",""],["","","Metoprol Tar Tab","25 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Atorvastatin Tab","80 MG","","Select","Select",""],["","","Lisinopril Tab","2.5 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","Select","Select",""],["","","Prednisone Tab","10 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":""}]}]}