{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA K GRIMES","gend":1,"currentgend":"","add":"224 E Oak Meadows","city":"Derby","state":"KS","zip":"67037","age":"","mstatus":"","insh":"K44009058","cliId":"","pno":"3166500881","cno":"","email":"twinpeaks292@yahoo.com","ename":"","eno":"","pphy":"ALISON RAYMOND","ppno":"3167377441","pcpadd":"2918 N PARKDALE CT","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67205-6039","pcpcounty":"","pcpid":"","pcpname":"WEST WICHITA FAMILY PHYSICIANS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1568690022","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009058","medicareid":"7KJ0VM9TR09","medicaidid":"7KJ0VM9TR09","pcpFlag":"","dob":"1957-06-12"},{"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":["Z950","I10","Z23","G4733","R000","I340","I495","E11618","F320","I4891","N1831","R809","M79606","I129","E8352","E559","E7849","I350","Z952","E6609","Z6834","I480","E6601","L659","R051","J189","J9601","N179","R791","R7989","I38","I2510","I509","R748","E119","N1830","E1165","Z20822","R0902","A419","I5033","N189","J449","Z87891","J9621","E1122","Z792","Z9981","Z8679","Z953","Z79899","I2720","J439","I5032","R0609","E663","Z6829","D631","E568","Z794","R0602","I498","F32A","Z7901","E1140","I110","E669","F39","K761","E785","E861","Z888","Z7982","Z7952","Z6832","J9622","J440","B379","D649","Z6830","I071","R6520","Z8701","R0600","F329"],"date":["2026-05-20","2026-05-26","2025-12-05","2025-12-05","2025-12-11","2025-12-11","2026-04-07","2025-03-06","2025-03-06","2026-03-06","2026-04-23","2025-03-06","2025-03-06","2025-04-07","2026-04-23","2026-02-05","2026-04-23","2025-04-07","2026-03-30","2025-04-07","2025-04-07","2026-02-12","2025-06-12","2026-02-05","2026-02-05","2026-03-30","2026-02-12","2026-03-06","2026-02-12","2026-02-12","2026-02-12","2026-04-07","2026-02-12","2026-02-12","2026-04-07","2026-03-06","2026-03-06","2026-02-08","2026-03-02","2026-03-06","2026-03-06","2026-03-11","2026-03-06","2026-04-07","2026-03-06","2026-04-23","2026-03-06","2026-03-02","2026-03-11","2026-04-07","2026-03-02","2026-04-07","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-04-23","2026-04-23","2026-04-23","2026-03-06","2026-03-06","2026-03-11","2026-04-07","2026-02-08","2026-02-08","2026-03-02","2026-03-02","2026-02-08","2026-03-02","2026-02-08","2026-02-08","2026-02-08","2026-02-08","2026-02-08","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-04-07","2026-04-07"],"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":[["","","POTASSIUM CHLORIDE ER","20 MEQ","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (SR)","150 MG","","Select","Select",""],["","","MOUNJARO","15 MG","","Select","Select",""],["","","BUMETANIDE","1 MG","","Select","Select",""],["","","WARFARIN SODIUM","4 MG","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","25 MG","","Select","Select",""],["","","VASCEPA","1 GM","","Select","Select",""],["","","EMBECTA PEN NEEDLE\/ULTRA-FINE\/31G X 5MM","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","100 MCG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","CEFUROXIME AXETIL","250 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","BUDESONIDE","0.5 MG","","Select","Select",""],["","","Warfarin Tab","6 MG","","Select","Select",""],["","","Mounjaro Inj 12.5\/0.5","","","Select","Select",""],["","","Metoprol Tar Tab","25 MG","","Select","Select",""],["","","Doxycycl Hyc Cap","100 MG","","Select","Select",""],["","","Fluconazole Tab","150 MG","","Select","Select",""],["","","Rosuvastatin Tab","40 MG","","Select","Select",""],["","","Bupropion Tab","150 MG","","Select","Select",""],["","","Pot Chloride Tab","20 MEQ","","Select","Select",""],["","","Pot Cl Micro Tab","20 MEQ","","Select","Select",""],["","","Cefuroxime Tab","250 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 7.5-325","","","Select","Select",""],["","","Bumetanide Tab","1 MG","","Select","Select",""],["","","Novolog Inj Flexpen","","","Select","Select",""],["","","Vascepa Cap","1 GM","","Select","Select",""],["","","Lantus Solos Inj 100\/Ml","","","Select","Select",""],["","","Budesonide Sus","0.5 MG","","Select","Select",""],["","","Amoxicillin Tab","500 MG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Embecta Uf Mis 31Gx5Mm","","","Select","Select",""],["","","Mounjaro Inj 2.5\/0.5","","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Cefdinir Cap","300 MG","","Select","Select",""],["","","Mounjaro Inj","15 MG","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","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":""}]}]}