{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON S BRICKELL","gend":1,"currentgend":"","add":"4430 BAUER FARM DR","city":"LAWRENCE","state":"KS","zip":"66049","age":"","mstatus":"","insh":"K44011070","cliId":"","pno":"3163056175","cno":"","email":"sharonbrickell1940@gmail.com","ename":"","eno":"","pphy":"MATTHEW BIHLMAIER","ppno":"7858432411","pcpadd":"1112 W 6TH ST","pcpcity":"LAWRENCE","pcpstate":"KS","pcpzip":"66044-1361","pcpcounty":"","pcpid":"","pcpname":"LMH HEALTH PRIMARY CARE - FREE STATE","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT 234","add3":"","madd1":"4430 BAUER FARM DR","madd2":"APT 234","madd3":"","mcity":"LAWRENCE","mstate":"KS","mzip":"66049","pcpfaxno":"","pcpnpi":"1619276979","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44011070","medicareid":"8UJ0A02KX44","medicaidid":"8UJ0A02KX44","pcpFlag":"","dob":"1940-12-18"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["M542","S199XXA","S0083XA","Z7901","W1839XA","K8689","I898","I4891","M7989","R269","M19012","Z7689","I2720","I071","E1140","K449","K219","R599","I480","I10","I081","Z95818","Z79899","I252","I454","R9431","M79601","W19XXXA","E119","H353211","R159","K862","Z7984","H353122","R197","R748","M5412","R300","R600","Z7902","Z961","Z947","H401134","M79605","I083","H3530","I119","S51011A","Z23","M47812","R921","R0789","R195","K529","Z860101","Z8711","Z0000","Z780","R5383","M25511","M4802"],"date":["2025-07-02","2025-07-02","2025-07-02","2025-07-02","2025-07-02","2025-06-27","2025-06-27","2026-04-30","2025-06-26","2025-06-26","2025-06-26","2026-04-30","2026-04-30","2025-10-01","2026-04-30","2025-06-27","2025-10-04","2025-06-27","2025-07-29","2026-04-30","2025-07-29","2025-07-29","2026-01-28","2025-07-29","2025-07-29","2025-07-29","2025-07-02","2025-07-02","2026-04-30","2025-08-20","2025-10-04","2026-04-30","2025-12-09","2026-03-12","2025-12-05","2025-12-05","2026-04-28","2026-04-28","2025-12-09","2025-05-05","2025-04-04","2025-04-04","2025-04-04","2025-04-16","2025-05-05","2025-06-26","2025-06-27","2025-07-02","2025-07-02","2025-07-02","2025-10-01","2026-01-28","2026-04-28","2026-03-05","2026-03-05","2026-03-05","2026-04-30","2026-04-30","2026-04-30","2026-01-07","2026-01-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","GABAPENTIN","300 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","DILTIAZEM HYDROCHLORIDE ER","180 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","50 MG","","Select","Select",""],["","","GLIMEPIRIDE","2 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","DAPAGLIFLOZIN PROPANEDIOL","10 MG","","Select","Select",""],["","","LATANOPROST","0.01%","","Select","Select",""],["","","DORZOLAMIDE HCL\/TIMOLOL MALEATE","","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","DAPAGLIFLOZIN","10 MG","","Select","Select",""],["","","COLESTIPOL HYDROCHLORIDE","1 GM","","Select","Select",""],["","","PREDNISOLONE ACETATE","1%","","Select","Select",""],["","","CONTOUR NEXT ONE BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","CONTOUR NEXT EZ BLOOD GLUCOSE MONITORING SYSTEM","","","Select","Select",""],["","","COMIRNATY 2025-26","3 ML","","Select","Select",""],["","","CONTOUR NEXT BLOOD GLUCOSE TEST","","","Select","Select",""],["","","EYSUVIS","0.25%","","Select","Select",""],["","","FARXIGA","10 MG","","Select","Select",""],["","","LOTEPREDNOL ETABONATE","0.20%","","Select","Select",""],["","","XIFAXAN","550 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","Comirnaty Inj 30\/.3Ml","","","Select","Select",""],["","","Eysuvis Dro 0.25%","","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Diltiazem Cap","180 MG","","Select","Select",""],["","","Losartan Pot Tab","50 MG","","Select","Select",""],["","","Farxiga Tab","10 MG","","Select","Select",""],["","","Dapagliflozi Tab","10 MG","","Select","Select",""],["","","Xifaxan Tab","550 MG","","Select","Select",""],["","","Creon Cap 36000Unt","","","Select","Select",""],["","","Latanoprost Sol 0.005%","","","Select","Select",""],["","","Furosemide Tab","20 MG","","Select","Select",""],["","","Contour Tes Next","","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Loteprednol Sus 0.2%","","","Select","Select",""],["","","Contour Next Mis One","","","Select","Select",""],["","","Glimepiride Tab","2 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Metformin Tab","1000 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Contour Kit Next Ez","","","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":""}]}]}