{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERRY D RENFRO","gend":1,"currentgend":"","add":"417 Exchange Street","city":"Emporia","state":"KS","zip":"66801","age":"","mstatus":"","insh":"K44009375","cliId":"","pno":"6207576150","cno":"","email":"sherrydarlenerenfro@gmail.com","ename":"","eno":"","pphy":"AMANDA RUXTON","ppno":"6203432500","pcpadd":"2522 W 15TH AVE","pcpcity":"EMPORIA","pcpstate":"KS","pcpzip":"66801-2588","pcpcounty":"","pcpid":"","pcpname":"INTEGRITY MEDICAL LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"417 Exchange Street","madd2":"","madd3":"","mcity":"Emporia","mstate":"KS","mzip":"66801","pcpfaxno":"6203432828","pcpnpi":"1457511321","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009375","medicareid":"5GA7RP9MN39","medicaidid":"5GA7RP9MN39","pcpFlag":"","dob":"1954-05-27"},{"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":["N184","R92323","H5211","H5202","H52222","H524","R350","N3281","M7989","Z452","D508","E049","G988","H5310","I10","L299","C641","E048","N83201","R5383","N838","M25511","M7918","M25562","Z96652","N3941","G4733","J3489","R7301","N1832","Z87440","L84","J984","M19021","R9389"],"date":["2026-03-18","2025-09-17","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2025-09-17","2025-09-17","2025-09-19","2025-04-11","2025-04-17","2026-03-18","2025-04-17","2025-04-17","2026-05-29","2025-04-17","2026-05-22","2025-04-14","2025-04-14","2026-03-13","2026-03-18","2026-01-20","2026-01-13","2026-01-13","2026-05-22","2026-01-13","2026-05-29","2026-01-13","2026-01-29","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-01-20","2026-05-04"],"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":[["","","CLINDAMYCIN HYDROCHLORIDE","300 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","15 MG","","Select","Select",""],["","","ADACEL","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","5 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE","30 MG","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","5 MG","","Select","Select",""],["","","FARXIGA","5 MG","","Select","Select",""],["","","MYRBETRIQ","25 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","MNEXSPIKE COVID-19 VACCINE\/2025-26","","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","SPIKEVAX COVID-19 VACCINE\/2024-25","","","Select","Select",""],["","","PERMETHRIN","5%","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE PHOSPHATE","30 MG","","Select","Select",""],["","","IVERMECTIN","3 MG","","Select","Select",""],["","","DAPAGLIFLOZIN PROPANEDIOL","5 MG","","Select","Select",""],["","","Permethrin Cre 5%","","","Select","Select",""],["","","Apap\/Codeine Tab 300-30Mg","","","Select","Select",""],["","","Farxiga Tab","5 MG","","Select","Select",""],["","","Dapagliflozi Tab","5 MG","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Ciprofloxacn Tab","500 MG","","Select","Select",""],["","","Cyclobenzapr Tab","5 MG","","Select","Select",""],["","","Baclofen Tab","10 MG","","Select","Select",""],["","","Oxybutynin Tab","5 MG","","Select","Select",""],["","","Ivermectin Tab","3 MG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Myrbetriq Tab","50 MG","","Select","Select",""],["","","Lisinopril Tab","20 MG","","Select","Select",""],["","","Spikevax Inj 2024-25","","","Select","Select",""],["","","Amlodipine Tab","2.5 MG","","Select","Select",""],["","","Mnexspike Inj 2025-26","","","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":""}]}]}