{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRY M PATRY","gend":0,"currentgend":"","add":"726 N FLORA ST","city":"WICHITA","state":"KS","zip":"67212","age":"","mstatus":"","insh":"K44008977","cliId":"","pno":"3167894084","cno":"","email":"","ename":"","eno":"","pphy":"LARRY DERKSEN","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":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"726 N FLORA ST","madd2":"","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"67212","pcpfaxno":"","pcpnpi":"1760493779","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44008977","medicareid":"4G75TK1TN65","medicaidid":"4G75TK1TN65","pcpFlag":"","dob":"1952-10-03"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03116","C9110","E782","Z8546","I10","I82533","Z86711","Z86718","Z7901","J069"],"date":["2025-09-30","2025-09-30","2025-09-30","2025-09-30","2026-03-24","2025-01-02","2025-03-27","2025-03-27","2025-03-27","2026-03-24"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","MUPIROCIN","2%","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","FLECAINIDE ACETATE","50 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Flecainide Tab","50 MG","","Select","Select",""],["","","Prevnar 20 Inj","","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Doxycycl Hyc Tab","100 MG","","Select","Select",""],["","","Mupirocin Oin 2%","","","Select","Select",""],["","","Lisinopril Tab","40 MG","","Select","Select",""],["","","Hydrochlorot Tab","25 MG","","Select","Select",""],["","","Cefdinir Cap","300 MG","","Select","Select",""],["","","Amlodipine Tab","5 MG","","Select","Select",""],["","","Atorvastatin Tab","40 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":""}]}]}