{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT T BOTINELLY","gend":0,"currentgend":"","add":"363 N Brunswick St","city":"Wichita","state":"KS","zip":"67212","dob":"1960-09-25","age":"","mstatus":"","insh":"K44010182","cliId":"","pno":"3167121739","cno":"","email":"","ename":"","eno":"","pphy":"DAWNELE TAYLOR","ppno":"3167222138","pcpadd":"245 N WACO ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67204-1844","pcpcounty":"","pcpid":"","pcpname":"HOUSE CALL MEDICAL SERVICES LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"363 N Brunswick St","madd2":"","madd3":"","mcity":"Wichita","mstate":"KS","mzip":"67212","pcpfaxno":"3167725559","pcpnpi":"1215186879","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44010182","medicareid":"2HC9P97DT34","medicaidid":"2HC9P97DT34","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":["F4001","E039","M79671","M79672","Z1331","F339","F419","F429","G4701","Z5989","Z79899","R413","R2681","R42","M79674","H5712","K08109","Z7984","E119","E785","E559"],"date":["2026-05-31","2026-06-15","2026-01-27","2026-06-15","2025-07-08","2026-06-15","2026-06-15","2026-06-15","2026-03-24","2026-06-15","2026-06-15","2025-11-18","2026-01-27","2026-06-15","2025-01-24","2025-05-12","2025-05-12","2026-03-24","2026-06-15","2026-06-15","2026-06-15"],"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":[["","","MEMANTINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","DONEPEZIL HCL","10 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","88 MCG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","BUSPIRONE HYDROCHLORIDE","30 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","10 MG","","Select","Select",""],["","","PAROXETINE HYDROCHLORIDE","20 MG","","Select","Select",""],["","","MECLIZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","AMOXICILLIN","875 MG","","Select","Select",""],["","","CLONAZEPAM","1 MG","","Select","Select",""],["","","PAROXETINE HCL","30 MG","","Select","Select",""],["","","Levothyroxin Tab","88 MCG","","Select","Select",""],["","","Meclizine Tab","25 MG","","Select","Select",""],["","","Paroxetine Tab","30 MG","","Select","Select",""],["","","Clonazepam Tab","0.5 MG","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Buspirone Tab","30 MG","","Select","Select",""],["","","Donepezil Tab","10 MG","","Select","Select",""],["","","Amoxicillin Tab","875 MG","","Select","Select",""],["","","Memantine Tab Hcl","5 MG","","Select","Select",""],["","","Zolpidem Tab","10 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":""}]}]}