{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALAN D MULYCK JR","gend":0,"currentgend":"","add":"6620 W Ocieo St","city":"WICHITA","state":"KS","zip":"67205","dob":"1960-11-09","age":"","mstatus":"","insh":"K44010133","cliId":"","pno":"3168710327","cno":"","email":"","ename":"","eno":"","pphy":"BAOLUAN NGUYEN","ppno":"3162606363","pcpadd":"7329 W VILLAGE CIR","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67205-1555","pcpcounty":"","pcpid":"","pcpname":"ICT INTERNAL MEDICINE AND PAIN MANAGEMENT LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"3162606301","pcpnpi":"1861682247","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44010133","medicareid":"1F82KJ4XA87","medicaidid":"1F82KJ4XA87","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":["G4733","J9611","M961","M5116","M4316","M533","M48061","M1611","M25552","Z79891","Z5181","F17210","M160","J449","Z720","R0902","I10","K219","G8929","R911","Z122","Z23","Z79899","R609","R600","E782","R601","R309","R7303","M1612","M25551","M4326","M5416","D508","Z981","M51360","N452","N433","N50811","M47816","M51362","M9973","E6601","Z7951","Z6835","Z7982","Z8709","Z9981","J432","R918"],"date":["2026-06-04","2026-06-04","2026-06-02","2026-05-05","2026-06-02","2026-06-02","2026-05-05","2025-08-26","2025-08-26","2026-06-02","2026-06-02","2026-05-29","2026-06-02","2026-03-02","2025-12-10","2025-12-10","2026-03-02","2025-12-10","2026-04-27","2025-12-10","2025-12-10","2025-12-10","2025-04-29","2025-01-02","2025-02-13","2025-04-29","2025-03-04","2025-03-04","2025-04-29","2025-05-05","2025-05-05","2025-05-05","2025-05-05","2025-04-29","2026-06-02","2026-02-04","2026-04-21","2026-04-14","2026-03-31","2026-06-02","2026-06-02","2026-06-02","2026-03-02","2026-03-02","2026-03-02","2026-04-27","2026-04-27","2026-04-27","2026-05-29","2026-05-29"],"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":[["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREGABALIN","150 MG","","Select","Select",""],["","","VARENICLINE STARTING MONTH","1 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10 MG","","Select","Select",""],["","","VARENICLINE TARTRATE","1 MG","","Select","Select",""],["","","BUDESONIDE","0.5 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","200 MCG","","Select","Select",""],["","","MORPHINE SULFATE ER","30 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","LEVOFLOXACIN","500 MG","","Select","Select",""],["","","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE","","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","150 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE","100 MG","","Select","Select",""],["","","FENOFIBRATE MICRONIZED","134 MG","","Select","Select",""],["","","FENOFIBRATE","130 MG","","Select","Select",""],["","","ZEPBOUND","","","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":""}]}]}