{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN R DICK","gend":0,"currentgend":"","add":"4935 S BROOKHAVEN ST","city":"WICHITA","state":"KS","zip":"672163402","dob":"1952-03-27","age":"","mstatus":"","insh":"K44009386","cliId":"","pno":"3165241773","cno":"","email":"blackwallnutjd@hotmail.com","ename":"","eno":"","pphy":"JENNIFER FRANKS","ppno":"3166899111","pcpadd":"14700 W ST TERESA ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"37208-3079","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1700130499","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009386","medicareid":"1NV8DT3VM34","medicaidid":"1NV8DT3VM34","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R531","M25661","H1013","J301","H01003","H01006","L719","H18513","H25812","H2511","I480","E119","N400","J4520","R5383","E7800","I10","M8580","D649","R9720","N3941","R3912","R110","R29818","I4892","Z96653","T8484XA","W1830XA","H01009","M5489","M5033","E669","Z87891","R9082","J45909","Z7951","Z7901","Z79899","H8110","H43813","H25811","Z131","M8589","I2510","M5450","I440","K219","E785","M85851","M85852","M5010","H6123","R6884","M65351"],"date":["2025-06-17","2025-06-17","2025-08-18","2025-06-23","2026-01-28","2026-01-28","2026-01-28","2026-01-28","2025-12-12","2025-12-12","2025-01-27","2026-02-24","2026-02-24","2025-01-27","2026-02-24","2025-02-09","2026-02-24","2025-01-27","2026-02-24","2026-05-18","2026-05-18","2025-02-07","2025-02-09","2025-02-09","2026-02-24","2025-05-05","2025-05-05","2025-05-05","2025-05-09","2025-06-06","2025-06-06","2025-02-09","2025-02-09","2025-02-09","2025-02-09","2025-02-09","2025-02-09","2025-02-09","2025-04-07","2026-01-28","2026-01-28","2026-02-13","2026-02-16","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2026-02-16","2026-02-16","2026-04-13","2026-05-05","2026-06-19","2026-06-03"],"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",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLECAINIDE ACETATE","150 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","NEOMYCIN\/POLYMYXIN\/DEXAMETHASONE","0.10%","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","50 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","ELIQUIS","5 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","FLUOROMETHOLONE","0.10%","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","15 MG","","Select","Select",""],["","","OFLOXACIN","0.30%","","Select","Select",""],["","","ALFUZOSIN HCL ER","10 MG","","Select","Select",""],["","","MUPIROCIN","2%","","Select","Select",""],["","","IPRATROPIUM BROMIDE","0.06%","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","0.50%","","Select","Select",""],["","","MECLIZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","ONDANSETRON HYDROCHLORIDE","8 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","Fluoromethol Sus 0.1% Op","","","Select","Select",""],["","","Comirnaty Inj 30\/.3Ml","","","Select","Select",""],["","","Meclizine Tab","25 MG","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Losartan Pot Tab","50 MG","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Doxycycl Hyc Cap","100 MG","","Select","Select",""],["","","Ketorolac Sol 0.5% Op","","","Select","Select",""],["","","Ofloxacin Dro 0.3% Op","","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Cyclobenzapr Tab","5 MG","","Select","Select",""],["","","Neo\/Poly\/Dex Sus 0.1% Op","","","Select","Select",""],["","","Flecainide Tab","150 MG","","Select","Select",""],["","","Doxycycl Hyc Tab","100 MG","","Select","Select",""],["","","Prednisolone Sus 1% Op","","","Select","Select",""],["","","Oxybutynin Tab","15 MG","","Select","Select",""],["","","Ondansetron Tab","8 MG","","Select","Select",""],["","","Oxycod\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Neo\/Poly\/Dex Oin 0.1% Op","","","Select","Select",""],["","","Amlodipine Tab","5 MG","","Select","Select",""],["","","Tamsulosin Cap","0.4 MG","","Select","Select",""],["","","Atorvastatin Tab","40 MG","","Select","Select",""],["","","Omeprazole Cap","40 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","Select","Select",""],["","","Eliquis Tab","5 MG","","Select","Select",""],["","","Meloxicam Tab","15 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":""}]}]}