{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELAINE A CLAMPITT","gend":1,"currentgend":"","add":"1350 N Minisa Dr","city":"Wichita","state":"KS","zip":"67203","age":"","mstatus":"","insh":"K44009318","cliId":"","pno":"3169423435","cno":"","email":"eclampitt8@gmail.com","ename":"","eno":"","pphy":"DONNA SWEET","ppno":"3166609768","pcpadd":"1001 N MINNEAPOLIS ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67214-3127","pcpcounty":"","pcpid":"","pcpname":"UKSM-WICHITA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1982679478","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009318","medicareid":"6TF9ND1GW59","medicaidid":"6TF9ND1GW59","pcpFlag":"","dob":"1954-03-27"},{"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":["Z7984","Z6825","L97812","L97822","I87313","S81801A","E119","R2681","S82142A","R109","S80211A","L97212","Z794","E785","I495","I469","R570","S82209A","Z98890","E860","R2689","R531","I214","S93432A","S82155A","K529","E1140","S82832A","W19XXXA","R001","I428","R42","I480","I340","Z743","S93432D","S82155D","M25462","I4901","E782","Z79899","I509","F32A","K219","I2510","N139","K5900","I110","E875","F419","I10","Z23","Z8674","R0602","N179","F331","F341","M79675","B351","E1151","F329","N319","E1142","M25572","R7989","R072","R338","I25119","R079","R0609","R5383","I442","I491","I87312","L97821","I87311","L97811","I951","H0288A","H0288B","H2513","H5203","H52223","H524","Z6826","R600","K760","M2042","I739","L853","L603","L84","M79672","M79671","S81812D","S51801A","Z87891","M79661","S81821A","R0682","B370","J449","R112","D72829","S82152A","G9340","N390","D696","I779","I6523","E1159","I872","M4802","E538","S80212A","M5430","S82402A","B9562","Z9181","Z955","Z8619","Z7902","S8292XD","M6281","Z7409","Z8679","J309","R339","I5032","E8342","E876","R8271","T43215A","Z7982","Z79891","Z882","S81802D","T50995D","G4700","M1991","G2581","B3789","B182","G510","S81802A","Z7985","M96A3","M549","G4736","B1920","R296","Z466","Z95811","M5440","G8929","Z8673","Z95828","H16223","R0600","S81001A","L438","L821","D692","Z7189","Z08","Z85828","L929","S82402D","S82209D"],"date":["2026-03-31","2025-06-11","2025-06-24","2025-06-24","2025-06-24","2025-11-04","2026-04-27","2025-08-01","2025-06-28","2025-06-29","2025-06-29","2025-06-11","2025-06-11","2026-03-17","2025-07-08","2025-08-08","2025-07-11","2025-08-06","2025-07-01","2025-08-23","2025-08-23","2025-05-27","2025-07-21","2025-07-01","2025-06-30","2025-06-02","2025-08-01","2025-07-08","2025-07-01","2026-03-17","2025-07-21","2025-08-18","2025-08-18","2025-08-18","2025-07-01","2025-07-23","2026-01-23","2025-07-23","2025-07-10","2026-04-27","2026-04-27","2025-08-14","2025-12-17","2026-01-23","2026-03-17","2025-08-08","2025-08-08","2025-08-23","2025-08-08","2026-03-31","2026-03-17","2025-09-03","2026-03-31","2025-08-25","2025-08-23","2026-03-31","2025-10-06","2025-10-15","2025-10-15","2025-10-15","2026-01-23","2026-01-23","2026-01-23","2025-11-04","2025-08-22","2025-08-18","2025-12-18","2025-12-19","2026-03-17","2025-12-19","2025-12-19","2025-12-19","2026-03-17","2025-12-09","2026-04-14","2026-01-06","2026-04-14","2026-01-23","2025-01-23","2025-01-23","2025-01-23","2026-02-05","2026-02-05","2026-02-05","2025-02-26","2026-01-06","2025-03-05","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-02-27","2025-05-08","2026-02-23","2025-04-24","2025-05-22","2025-05-26","2026-05-15","2026-01-23","2025-05-30","2025-05-31","2025-07-08","2025-06-29","2026-06-15","2025-06-29","2025-06-29","2025-06-29","2025-06-29","2026-01-23","2025-06-29","2025-07-08","2025-06-29","2025-06-29","2025-07-08","2025-07-08","2026-01-23","2026-03-31","2025-07-08","2026-03-31","2025-08-01","2025-08-01","2025-08-01","2025-08-01","2025-08-01","2026-03-31","2025-08-23","2025-08-23","2025-08-23","2025-08-23","2025-08-23","2026-01-23","2025-08-23","2026-02-23","2025-06-27","2025-06-27","2026-01-23","2025-06-27","2025-06-27","2025-06-27","2025-06-27","2025-06-27","2025-06-09","2025-06-09","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2026-02-05","2026-03-17","2026-05-12","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-06-15","2026-03-31","2026-03-31"],"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":[["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","10 MG","","Select","Select",""],["","","VALACYCLOVIR HYDROCHLORIDE","1 GM","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","LINZESS","72 MCG","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","TICAGRELOR","90 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","MIRTAZAPINE","15 MG","","Select","Select",""],["","","TRINTELLIX","5 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE","100 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE DENTAL PASTE","0.10%","","Select","Select",""],["","","MICROLET LANCETS","","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","CONTOUR NEXT GEN BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","PREDNISONE","5 MG","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","30 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","DESVENLAFAXINE ER","50 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","OMEPRAZOLE DR","20 MG","","Select","Select",""],["","","FLUOXETINE HYDROCHLORIDE","20 MG","","Select","Select",""],["","","FLUCONAZOLE","100 MG","","Select","Select",""],["","","ALPRAZOLAM","0.25 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000 MG","","Select","Select",""],["","","AMIODARONE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS\/SENSOR\/GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","GEMTESA","75 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","MOUNJARO","5 MG","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE","30 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","20 MG","","Select","Select",""],["","","FREESTYLE LIBRE 3\/SENSOR\/GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","Nystatin Sus 100000","","","Select","Select",""],["","","Apap\/Codeine Tab 300-30Mg","","","Select","Select",""],["","","Mirtazapine Tab","30 MG","","Select","Select",""],["","","Doxycyc Mono Cap","100 MG","","Select","Select",""],["","","Oxycod\/Apap Tab 10-325Mg","","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Trintellix Tab","10 MG","","Select","Select",""],["","","Linzess Cap","72 MCG","","Select","Select",""],["","","Ciprofloxacn Tab","500 MG","","Select","Select",""],["","","Microlet Mis Lancets","","","Select","Select",""],["","","Desvenlafax Tab","50 MG","","Select","Select",""],["","","Isosorb Mono Tab","30 MG","","Select","Select",""],["","","Fluconazole Tab","150 MG","","Select","Select",""],["","","Prednisone Tab","5 MG","","Select","Select",""],["","","Valacyclovir Tab","1 GM","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Mounjaro Inj","5 MG","","Select","Select",""],["","","Alprazolam Tab","0.25 MG","","Select","Select",""],["","","Solifenacin Tab","10 MG","","Select","Select",""],["","","Contour Tes Next","","","Select","Select",""],["","","Oxycod\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Ondansetron Tab","4 MG","","Select","Select",""],["","","Gemtesa Tab","75 MG","","Select","Select",""],["","","Furosemide Tab","40 MG","","Select","Select",""],["","","Fluoxetine Cap","20 MG","","Select","Select",""],["","","Lisinopril Tab","10 MG","","Select","Select",""],["","","Freesty Libr Kit 3 Sensor","","","Select","Select",""],["","","Free Libre3 Kit Plus\/Sen","","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Oxycodone Tab","5 MG","","Select","Select",""],["","","Amiodarone Tab","100 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Cyclobenzapr Tab","10 MG","","Select","Select",""],["","","Metformin Tab","1000 MG","","Select","Select",""],["","","Amlodipine Tab","2.5 MG","","Select","Select",""],["","","Trazodone Tab","50 MG","","Select","Select",""],["","","Escitalopram Tab","20 MG","","Select","Select",""],["","","Triamcinolon Pst Den 0.1%","","","Select","Select",""],["","","Nitrofurantn Cap","100 MG","","Select","Select",""],["","","Contour Next Kit Gen","","","Select","Select",""],["","","Simvastatin Tab","20 MG","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","Select","Select",""],["","","Ticagrelor Tab","90 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":""}]}]}