{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISE FISHER","gend":1,"currentgend":"","add":"1071 Verda","city":"Wichita","state":"KS","zip":"67203","age":"","mstatus":"","insh":"K44009520","cliId":"","pno":"3169425586","cno":"","email":"LISE.FISHER@YAHOO.COM","ename":"","eno":"","pphy":"GERALD NIERNBERGER","ppno":"3166094501","pcpadd":"14700 W SAINT TERESA ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67206-2900","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":"1417986894","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009520","medicareid":"6QQ6ED3GH47","medicaidid":"6QQ6ED3GH47","pcpFlag":"","dob":"1944-03-31"},{"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":["N1832","R8290","D649","W458XXA","Y92018","Z23","H02831","H02834","H43813","H52221","H524","D631","I129","E1329","M1990","E1122","I10","N1830","J309","E7800","N9089","E119","N19","R1010","R140","M7989","J069","E559","R809"],"date":["2025-08-26","2025-08-18","2026-04-28","2025-10-16","2025-10-16","2025-10-16","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2025-12-15","2025-08-26","2026-04-28","2026-04-28","2026-04-28","2026-04-28","2026-04-28","2025-06-09","2025-03-05","2026-01-20","2025-06-09","2026-03-24","2026-01-20","2026-01-20","2026-02-23","2026-03-24","2026-03-24","2026-04-28","2026-04-28"],"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":[["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","CELECOXIB","100 MG","","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","300 MG","","Select","Select",""],["","","GLIPIZIDE ER","10 MG","","Select","Select",""],["","","DAPAGLIFLOZIN PROPANEDIOL","10 MG","","Select","Select",""],["","","JANUVIA","50 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","OZEMPIC","2 MG","","Select","Select",""],["","","DAPAGLIFLOZIN","10 MG","","Select","Select",""],["","","CLOBETASOL PROPIONATE","0.05%","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE\/SALMETEROL DISKUS","","","Select","Select",""],["","","Glipizide Er Tab","10 MG","","Select","Select",""],["","","Dapagliflozi Tab","10 MG","","Select","Select",""],["","","Hydroxyz Hcl Tab","25 MG","","Select","Select",""],["","","Ciprofloxacn Tab","500 MG","","Select","Select",""],["","","Clindamycin Cap","300 MG","","Select","Select",""],["","","Januvia Tab","50 MG","","Select","Select",""],["","","Clobetasol Cre 0.05%","","","Select","Select",""],["","","Flutic\/Salme Aer 250\/50","","","Select","Select",""],["","","Lisinopril Tab","20 MG","","Select","Select",""],["","","Ozempic Inj","2 MG","","Select","Select",""],["","","Atorvastatin Tab","40 MG","","Select","Select",""],["","","Azithromycin Tab","250 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":""}]}]}