{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY W SICKLES","gend":0,"currentgend":"","add":"12 ROBERTS CT","city":"Winfield","state":"KS","zip":"67156","dob":"1956-11-08","age":"","mstatus":"","insh":"K44011044","cliId":"","pno":"6204022820","cno":"","email":"","ename":"","eno":"","pphy":"MICHELLE BLAIRWUNDERLICH","ppno":"3169622000","pcpadd":"221 W 8TH AVE","pcpcity":"WINFIELD","pcpstate":"KS","pcpzip":"67214-4910","pcpcounty":"","pcpid":"","pcpname":"COMM HLTH CTR IN COWLEY CO INC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1902194996","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44011044","medicareid":"1KW0U96FF39","medicaidid":"1KW0U96FF39","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":["G928","J189","N186","J90","J441","R7881","G9341","J449","J9621","M6281","R262","Z741","R41841","Z9981","Z992","I120","E119","E1122","Z13220","Z1619","Z720","Z792","J9601","J9602","I509","I2510","M25551","W19XXXA","D631","N250","R600","R296","Z79891","I214","I5033","B9683","E875","E871","E66811","Z6832","Z91198","F411","R638","J4489","I953","I5032","G4733","F17210","J9611","R911","I5022","J9811","I517","I288","I700","G4719","R0683","I10","A419","R0602","J9622","E8729","I428","J440","I132","D696","D72823","E039","E11319","E1140","E1165","E785","E8339","D509","G2581","N400","E7849","G8929","Z8701","Z8616","Z5982","Z556","Z604","F419","Z7982","Z9089","Z23","I872","Z1331","Z560","I878","Z8619","Z713","Z7182","F17200","E669","Z6834","Z794","N2581","Z87891","Z7189","E8779","M79672","E1051","L84"],"date":["2025-06-11","2025-07-15","2026-06-12","2026-01-13","2025-07-15","2025-07-04","2025-07-15","2026-06-12","2025-06-25","2025-07-15","2025-07-15","2025-07-15","2025-07-15","2026-06-12","2026-06-12","2026-06-12","2025-07-17","2026-06-12","2025-06-27","2025-06-25","2025-06-25","2025-06-21","2025-07-15","2025-06-25","2025-06-25","2026-06-12","2025-12-02","2025-07-10","2026-06-12","2026-05-29","2025-06-24","2025-07-10","2026-05-12","2025-07-15","2025-07-11","2025-07-04","2025-07-17","2025-07-17","2025-07-15","2025-07-15","2025-07-15","2025-07-15","2025-07-02","2025-07-17","2025-07-17","2025-07-17","2026-06-12","2026-06-12","2026-03-12","2026-06-12","2026-03-12","2026-01-13","2025-10-21","2025-10-21","2026-06-12","2026-06-12","2025-06-05","2026-03-03","2025-07-15","2025-06-22","2025-06-22","2025-06-22","2026-06-12","2025-06-22","2025-06-22","2025-07-15","2025-06-22","2026-06-12","2025-06-22","2025-06-22","2025-06-22","2026-03-03","2025-06-22","2026-05-29","2025-07-15","2025-07-15","2026-06-12","2026-05-12","2026-06-12","2026-06-12","2026-06-12","2026-06-12","2026-06-12","2026-06-12","2025-11-13","2026-06-12","2025-10-31","2026-06-12","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2025-12-02","2026-02-19","2026-02-19","2026-05-04","2026-05-29","2026-03-03","2026-03-03","2026-05-29","2026-04-14","2026-04-14","2026-04-14"],"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":[["","","ALPRAZOLAM","0.25 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","ALFUZOSIN HCL ER","10 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","25 MG","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","150 MCG","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","26 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","BREYNA","","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","ENTRESTO","26 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Metoprol Tar Tab","25 MG","","Select","Select",""],["","","Entresto Tab 24-26Mg","","","Select","Select",""],["","","Sacub\/Valsar Tab 24-26Mg","","","Select","Select",""],["","","Hydroxyz Hcl Tab","25 MG","","Select","Select",""],["","","Doxycycl Hyc Cap","100 MG","","Select","Select",""],["","","Sertraline Tab","25 MG","","Select","Select",""],["","","Levothyroxin Tab","150 MCG","","Select","Select",""],["","","Alprazolam Tab","0.25 MG","","Select","Select",""],["","","Furosemide Tab","40 MG","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Alfuzosin Tab","10 MG","","Select","Select",""],["","","Amox\/K Clav Tab 500-125","","","Select","Select",""],["","","Atorvastatin Tab","40 MG","","Select","Select",""],["","","Breyna Aer 160\/4.5","","","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":""}]}]}