{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIMOTHY J HANNA","gend":0,"currentgend":"","add":"239 S Edgemoor St.","city":"WICHITA","state":"KS","zip":"67218","dob":"1950-02-10","age":"","mstatus":"","insh":"K44009872","cliId":"","pno":"3162042003","cno":"","email":"","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":"M3AK44009872","medicareid":"1MR2NM8XR85","medicaidid":"1MR2NM8XR85","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":["J939","W1839XA","M47816","M25511","M7521","M75111","S270XXA","Z9181","M48061","M4726","Z743","I10","E782","M109","R001","R5383","S0993XA","S0081XA","W19XXXA","S069XAA","R531","S0990XA","S3992XA","Z961","H524","M79644","R030","N401","Z125","S2239XA","L0390","H6120","D485"],"date":["2025-05-27","2025-05-27","2025-07-15","2025-07-15","2025-10-29","2025-10-29","2025-05-30","2025-05-30","2025-04-03","2025-04-03","2025-05-27","2025-11-18","2026-05-11","2026-05-11","2025-11-11","2026-05-11","2025-12-09","2025-12-09","2025-12-09","2026-05-11","2026-05-11","2025-12-09","2025-05-27","2025-01-23","2025-01-23","2025-04-15","2025-04-15","2025-05-20","2026-05-11","2025-06-05","2026-05-11","2026-05-11","2026-05-11"],"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":[["","","TAMSULOSIN HYDROCHLORIDE","0.4 MG","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","MUPIROCIN","2%","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","DILTIAZEM HYDROCHLORIDE ER","120 MG","","Select","Select",""],["","","PROPRANOLOL HYDROCHLORIDE","20 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","METHOCARBAMOL","500 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","INDOMETHACIN","50 MG","","Select","Select",""],["","","Indomethacin Cap","50 MG","","Select","Select",""],["","","Losartan Pot Tab","50 MG","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Propranolol Tab","20 MG","","Select","Select",""],["","","Diltiazem Cap","120 MG","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Mupirocin Oin 2%","","","Select","Select",""],["","","Oxycodone Tab","5 MG","","Select","Select",""],["","","Allopurinol Tab","300 MG","","Select","Select",""],["","","Finasteride Tab","5 MG","","Select","Select",""],["","","Tamsulosin Cap","0.4 MG","","Select","Select",""],["","","Methocarbam Tab","500 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":""}]}]}