{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA R BERNDT","gend":1,"currentgend":"","add":"806 N Parkridge St","city":"Wichita","state":"KS","zip":"67212","age":"","mstatus":"","insh":"K44009357","cliId":"","pno":"3162083782","cno":"","email":"lin_berndt@yahoo.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009357","medicareid":"4HN1YG4RJ06","medicaidid":"","pcpFlag":"","dob":"1942-01-09"},{"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":["H0102B","H04123","H401121","H26493","H52213","H16223","E039","E559","H35363","H401134","Z961","H5202","H52223","H524","Z96643","Z6821","M5450","Z780","M810","M8588","J479","E2740","J8281","A319","M5459","H608X1","R051","Z8701","E038","D508","D509","J101","A419","J17","J111","J1001","J45909","J189","E876","J168","Z9981","B351","R0902","J9690","Z20822","G4733","E782","E271","J4520","K580","E611","E8342","L89319","L821","D692","D1801","L578","R5383","H938X3","H6983","R0602","J159","J9601","J1008","J849","E871","F32A","K589","K219","R6520","E7800","M1990","R197","Z23","H409","H9190","Z96649","Z8619","Z79890","R509","J9621","J470","J9819","Z79899","Z881","L89321","Z713","R92323","L820","L538","R208","L570"],"date":["2026-03-23","2026-03-23","2025-06-11","2026-03-23","2026-03-23","2025-06-11","2026-01-12","2026-01-12","2026-03-23","2026-03-23","2026-03-23","2025-09-11","2025-09-11","2025-09-11","2025-09-24","2025-09-24","2025-10-03","2025-11-07","2025-11-07","2025-11-07","2026-06-10","2026-06-10","2026-06-10","2025-12-15","2026-01-19","2025-12-29","2025-12-29","2025-12-29","2026-04-16","2026-04-16","2025-02-03","2025-03-11","2025-03-26","2025-03-26","2025-03-08","2025-03-08","2025-06-02","2025-04-02","2025-03-11","2025-03-14","2025-03-14","2026-06-01","2025-03-14","2025-03-01","2025-03-24","2026-06-10","2025-04-22","2025-04-16","2025-04-16","2025-04-16","2025-04-22","2025-04-16","2025-04-29","2026-06-01","2025-04-29","2025-04-29","2025-04-29","2025-06-05","2025-06-18","2025-06-18","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2026-04-10","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-24","2025-03-24","2025-03-24","2025-03-24","2025-03-24","2025-03-24","2025-03-24","2026-01-21","2026-06-01","2026-02-16","2026-06-01","2026-06-01","2026-06-01","2026-06-01"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","LATANOPROST","0.01%","","Select","Select",""],["","","BRIMONIDINE TARTRATE","0.20%","","Select","Select",""],["","","MIRTAZAPINE","30 MG","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","HYDROCORTISONE","5 MG","","Select","Select",""],["","","MONTELUKAST SODIUM","10 MG","","Select","Select",""],["","","DORZOLAMIDE HYDROCHLORIDE","2%","","Select","Select",""],["","","CICLOPIROX NAIL LACQUER","8%","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","Select","Select",""],["","","LOVASTATIN","10 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","88 MCG","","Select","Select",""],["","","SYNTHROID","100 MCG","","Select","Select",""],["","","LEVALBUTEROL HYDROCHLORIDE","1.25 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","0.30%","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BETAXOLOL HCL","0.50%","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.03%","","Select","Select",""],["","","VALACYCLOVIR HYDROCHLORIDE","1 GM","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","DORZOLAMIDE HCL","2%","","Select","Select",""],["","","FUROSEMIDE","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":""}]}]}