{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA J HULTMAN","gend":1,"currentgend":"","add":"2022 TERRACE DR","city":"NEWTON","state":"KS","zip":"67114","age":"","mstatus":"","insh":"K44011139","cliId":"","pno":"9705905543","cno":"","email":"PULLET450@GMAIL.COM","ename":"","eno":"","pphy":"KESHA CRICHLOW","ppno":"3162836103","pcpadd":"720 MEDICAL CENTER DR","pcpcity":"NEWTON","pcpstate":"KS","pcpzip":"67114-8778","pcpcounty":"","pcpid":"","pcpname":"PRIMARY CARE PARTNERS HMC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"3162831333","pcpnpi":"1154746782","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44011139","medicareid":"7WK4JR8VX05","medicaidid":"7WK4JR8VX05","pcpFlag":"","dob":"1955-03-02"},{"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":["R0989","E785","H353124","H35383","N3010","R0602","Z130","Z1329","D649","H5203","H524","H52223","I517","J45909","R400","M5030","N951","M5441","R5383","K219","F5104","I6529","Z131","K5190","F418","H6991","J45901","J209","Z1239","R748","M5431","M25551","M1611","V199XXD","M25751","Z8781","D2262","D2261","L821","L820","R58","L538","Z789","R9431","R12","R945","R1310","K589","K317","K449","Z1211","K5790","I493","K5900","R7303","N898","M25532"],"date":["2026-05-11","2026-05-11","2025-12-17","2025-12-17","2025-08-15","2026-05-11","2025-09-11","2025-09-11","2026-02-19","2025-12-17","2025-12-17","2025-12-17","2026-05-11","2026-02-17","2025-05-19","2025-05-19","2026-02-17","2026-04-10","2025-05-19","2026-06-02","2025-08-15","2026-05-11","2025-08-15","2025-08-15","2026-04-10","2025-08-15","2025-10-10","2025-10-10","2025-05-19","2026-02-24","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-03-04","2026-04-09","2026-04-09","2026-04-09","2026-04-09","2026-04-09","2026-04-09","2026-04-09","2026-05-11","2026-06-02","2026-05-04","2026-05-04","2026-06-02","2026-06-02","2026-06-02","2026-06-02","2026-06-02","2026-02-17","2026-02-17","2026-02-17","2026-04-10","2026-04-10"],"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":[["","","MONTELUKAST SODIUM","10 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","PEG-3350\/ELECTROLYTES","","","Select","Select",""],["","","EZETIMIBE","10 MG","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50 MCG","","Select","Select",""],["","","RAMELTEON","8 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","AMITRIPTYLINE HYDROCHLORIDE","10 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","5 MG","","Select","Select",""],["","","FENOFIBRIC ACID DR","135 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","10 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","10 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","MYRBETRIQ","25 MG","","Select","Select",""],["","","ESTRADIOL","10 MCG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","MESALAMINE ER","0.375 GM","","Select","Select",""],["","","ARNUITY ELLIPTA","100 MCG","","Select","Select",""],["","","FLUTICASONE FUROATE ELLIPTA","200 MCG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4 MG","","Select","Select",""],["","","Mesalamine Cap","0.375 GM","","Select","Select",""],["","","Methylpred Tab","4 MG","","Select","Select",""],["","","Estradiol Cre 0.01%","","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Montelukast Tab","10 MG","","Select","Select",""],["","","Cyclobenzapr Tab","5 MG","","Select","Select",""],["","","Ezetimibe Tab","10 MG","","Select","Select",""],["","","Solifenacin Tab","10 MG","","Select","Select",""],["","","Escitalopram Tab","10 MG","","Select","Select",""],["","","Ramelteon Tab","8 MG","","Select","Select",""],["","","Fenofibric Cap","135 MG","","Select","Select",""],["","","Estradiol Tab","10 MCG","","Select","Select",""],["","","Arnuity Elpt Inh","200 MCG","","Select","Select",""],["","","Fluticas Fur Inh","200 MCG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Amitriptylin Tab","10 MG","","Select","Select",""],["","","Clopidogrel Tab","75 MG","","Select","Select",""],["","","Rosuvastatin Tab","5 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Myrbetriq Tab","25 MG","","Select","Select",""],["","","Omeprazole Cap","40 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","Select","Select",""],["","","Azithromycin Tab","250 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":""}]}]}