{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROL L SHUMAKER","gend":1,"currentgend":"","add":"10118 Briarwood St","city":"Wichita","state":"KS","zip":"67212","dob":"1946-04-13","age":"","mstatus":"","insh":"K44009867","cliId":"","pno":"3169927848","cno":"","email":"cshumaker109@gmail.com","ename":"","eno":"","pphy":"NICHOLE RIDDEL","ppno":"3167219500","pcpadd":"8444 W 21ST ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67205-1752","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":"1134430853","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44009867","medicareid":"2PR3CH1XV98","medicaidid":"2PR3CH1XV98","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":["R9431","I350","I4891","I10","I4892","Z9189","I6521","I5032","Z952","Z8774","Z006","Z7901","M51369","Z5181","M48062","Z981","M5126","R29890","Q2110","M48061","M4126","M4316","M4312","I3481","I340","I110","I5030","I480","I454","E785","M47816","Z98890","Z79899","I4821","I429","E669","I2510","Z96651","Z888","Z780","M8589","M85851","M85852","Z8679","R7301","E782","R109","M79676","K625","R1084","K5730","M21611","R0982","R053","K649","Z7902","Z882","Z6834","Z9049"],"date":["2025-06-05","2025-11-11","2026-04-02","2026-04-02","2025-11-11","2025-11-11","2025-01-23","2025-06-05","2026-04-07","2025-03-27","2025-03-26","2026-06-02","2025-04-03","2025-04-03","2025-04-03","2025-05-20","2025-05-29","2025-05-20","2025-06-05","2025-05-29","2025-05-29","2025-05-29","2025-07-22","2025-01-23","2025-01-23","2025-03-26","2026-04-02","2025-01-23","2025-01-23","2025-01-23","2025-01-23","2025-01-23","2026-03-25","2026-03-25","2025-03-26","2026-03-25","2025-03-26","2025-03-26","2026-03-25","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-02-12","2026-02-12","2026-04-02","2026-02-12","2026-02-12","2026-03-25","2026-03-25","2026-03-25","2026-06-02","2026-06-02","2026-06-02","2026-03-25","2026-03-25","2026-03-25","2026-03-25","2026-03-25"],"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":[["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","100 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","WARFARIN SODIUM","5 MG","","Select","Select",""],["","","ALLOPURINOL","100 MG","","Select","Select",""],["","","LOVASTATIN","20 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","COLCHICINE","0.6 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","PREDNISONE","5 MG","","Select","Select",""],["","","Furosemide Tab","80 MG","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Prednisone Tab","5 MG","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Allopurinol Tab","100 MG","","Select","Select",""],["","","Tizanidine Tab","4 MG","","Select","Select",""],["","","Pot Chloride Tab","20 MEQ","","Select","Select",""],["","","Warfarin Tab","5 MG","","Select","Select",""],["","","Metoprol Suc Tab","100 MG","","Select","Select",""],["","","Losartan Pot Tab","100 MG","","Select","Select",""],["","","Gabapentin Cap","100 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Lovastatin Tab","20 MG","","Select","Select",""],["","","Amlodipine Tab","2.5 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","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":""}]}]}