{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DALE R WEAVER","gend":0,"currentgend":"","add":"9734 W BIRCH LN","city":"WICHITA","state":"KS","zip":"67212","age":"","mstatus":"","insh":"K44009819","cliId":"","pno":"3167227313","cno":"","email":"weavedis@gmail.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9734 W BIRCH LN","madd2":"","madd3":"","mcity":"WICHITA","mstate":"KS","mzip":"672124417","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009819","medicareid":"6NK0UP7YN07","medicaidid":"6NK0UP7YN07","pcpFlag":"","dob":"1955-08-06"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","M79671","Z743","L02611","B9689","I739","E119","Z792","E1151","I10","M899","L97518","E1140","K219","Z87891","E1165","M869","M86171","Z4781","M1990","D72829","D649","F17200","R635","Q809","L309","F0280","I771","R419","Z125","Z1331","Z79899","M86071","L97509","I70201","L03031","M868X8","E1159","Z794","R4189","Z716","L905","E1152","I70261","M868X7","E11621","F0390","E1169","L97519","Z7982","E878","E8720","M4800","R262","M6281","Z741","M47819","L853","Z9852","Z89421","Z556","Z604","Z602","L97412","M6701","Z89431"],"date":["2026-04-30","2026-05-13","2026-01-20","2026-05-16","2026-02-04","2026-05-15","2026-05-16","2026-02-04","2026-05-16","2026-05-16","2026-02-03","2026-01-23","2026-01-23","2026-05-16","2026-01-23","2026-04-29","2026-01-19","2026-03-19","2026-04-30","2026-02-24","2026-02-24","2026-04-30","2026-04-30","2026-03-09","2026-03-31","2026-03-31","2026-03-31","2026-02-04","2026-02-04","2026-04-29","2026-04-29","2026-05-16","2026-01-20","2026-01-20","2026-04-30","2026-02-04","2026-02-04","2026-01-30","2026-05-16","2026-01-30","2026-05-08","2026-05-19","2026-02-04","2026-02-04","2026-02-04","2026-05-16","2026-04-30","2026-02-04","2026-02-04","2026-05-16","2026-02-04","2026-01-20","2026-01-20","2026-02-24","2026-02-24","2026-02-24","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-04-30","2026-05-16","2026-05-16","2026-05-16"],"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":[["","","PIOGLITAZONE HYDROCHLORIDE","30 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","JARDIANCE","25 MG","","Select","Select",""],["","","OZEMPIC","2 MG","","Select","Select",""],["","","MICROLET LANCETS","","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","CIPROFLOXACIN HCL","750 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","CONTOUR NEXT GEN BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","CEFADROXIL","500 MG","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","HUMALOG JUNIOR KWIKPEN","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","Jardiance Tab","25 MG","","Select","Select",""],["","","Pioglitazone Tab","30 MG","","Select","Select",""],["","","Ozempic Inj","2 MG","","Select","Select",""],["","","Atorvastatin Tab","40 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":""}]}]}