{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA WADSWORTH","gend":1,"currentgend":"","add":"1927 N Siefkin St","city":"Wichita","state":"KS","zip":"67208","dob":"1956-06-27","age":"","mstatus":"","insh":"K44010696","cliId":"","pno":"3165593491","cno":"","email":"","ename":"","eno":"","pphy":"JOHN MAY","ppno":"3167214544","pcpadd":"8200 W CENTRAL AVE","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67212-3661","pcpcounty":"","pcpid":"","pcpname":"WEST WICHITA FAMILY PHYSICIANS","plan":"BCBSKS","program":"Medicare","lob":"006","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1104054667","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44010696","medicareid":"2A19TP4PF24","medicaidid":"2A19TP4PF24","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":["J3489","L988","I160","R0609","I10","I340","I050","Z794","N390","E113293","H43813","L97529","G894","N189","R739","E11621","K8020","E559","R82998","N3289","B9620","T310","X118XXA","Y929","D508","E1140","R8271","Z7985","K838","L97501","K828","L97412","L97522","Z8739","F419","I071","R5381","R233","L97514"],"date":["2025-06-11","2025-06-11","2025-06-16","2025-06-16","2026-01-28","2025-06-16","2026-01-28","2026-05-06","2025-09-04","2025-11-25","2025-11-25","2026-05-06","2025-12-05","2025-12-10","2025-12-10","2025-12-10","2026-01-21","2026-06-02","2025-09-04","2025-09-04","2025-09-04","2025-02-12","2025-02-12","2025-02-12","2025-01-03","2026-03-31","2025-01-03","2026-01-14","2026-01-19","2026-01-21","2026-01-21","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-01-28","2026-06-02","2026-06-02","2026-03-27"],"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":[["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","AMPICILLIN","500 MG","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","VALACYCLOVIR HYDROCHLORIDE","1 GM","","Select","Select",""],["","","CONTOUR NEXT EZ BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","Select","Select",""],["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","10 MG","","Select","Select",""],["","","ALPRAZOLAM","0.5 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","MOUNJARO","10 MG","","Select","Select",""],["","","TOUJEO MAX SOLOSTAR","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","DROPLET PEN NEEDLES 32GX4MM","","","Select","Select",""],["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","CONTOUR NEXT GEN BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","OZEMPIC","2 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE","100 MG","","Select","Select",""],["","","NOVOFINE PEN NEEDLE 32G X 6MM","","","Select","Select",""],["","","MUPIROCIN","2%","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100 MG","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIPS","","","Select","Select",""],["","","Smz\/Tmp Ds Tab 800-160","","","Select","Select",""],["","","Hydroco\/Apap Tab 10-325Mg","","","Select","Select",""],["","","Novofine Mis 32Gx6Mm","","","Select","Select",""],["","","Pen Needles Mis 32Gx4Mm","","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Valacyclovir Tab","1 GM","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Alprazolam Tab","0.5 MG","","Select","Select",""],["","","Mounjaro Inj","5 MG","","Select","Select",""],["","","Onetouch Tes Verio","","","Select","Select",""],["","","Mupirocin Oin 2%","","","Select","Select",""],["","","Ampicillin Cap","500 MG","","Select","Select",""],["","","Contour Tes Next","","","Select","Select",""],["","","Novolog Inj Flexpen","","","Select","Select",""],["","","Dexcom G7 Mis Sensor","","","Select","Select",""],["","","Contour Next Mis Gen","","","Select","Select",""],["","","Mounjaro Inj 2.5\/0.5","","","Select","Select",""],["","","Ozempic Inj","4 MG","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Mounjaro Inj 7.5\/0.5","","","Select","Select",""],["","","Amlodipine Tab","2.5 MG","","Select","Select",""],["","","Toujeo Max Inj 300\/Ml","","","Select","Select",""],["","","Nitrofurantn Cap","100 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","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":""}]}]}