{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENISE T STACY","gend":1,"currentgend":"","add":"770 N silver Springs Blvd","city":"Wichita","state":"KS","zip":"67212","age":"","mstatus":"","insh":"K44011335","cliId":"","pno":"9133782468","cno":"","email":"","ename":"","eno":"","pphy":"WHITNEY NICHOLS","ppno":"6208722187","pcpadd":"1133 SW TOPEKA BLVD","pcpcity":"TOPEKA","pcpstate":"KS","pcpzip":"67871-6117","pcpcounty":"","pcpid":"","pcpname":"WEST WICHITA FAMILY PHYSICIANS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"APT 1403","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1013321728","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44011335","medicareid":"7CN0CH9MU34","medicaidid":"7CN0CH9MU34","pcpFlag":"","dob":"1956-03-31"},{"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":["R9402","H8110","G5603","F32A","R519","R279","R296","R42","R32","R1310","H52223","H524","R7303","M6281","R262","E860","I959","N390","Z7984","I10","F329","Z79899","G4700","D7210","Z136","R200","R202","H539","R159","R110","G8929","R630","R531","M7910","Z01812","R635","M549","K219","F419","R9082","R918","H906","H53149","R45851","E871","M5450","R109","M542","M25512","M25511","E785","R400","K449","R1013","N1832","E66812","Z6836","E6601","K2950","K429","K2930","K3189","E6689","R1084","H9202","N19","R413","F4310","K2100","R6881","K436","R5383","R197","R001","R9431","K420","E669","I129","E1122","Z6835","Z885","Z881"],"date":["2026-02-18","2026-02-18","2026-02-18","2026-02-18","2026-02-18","2025-08-19","2026-04-09","2025-12-02","2025-12-02","2025-08-19","2025-09-23","2025-09-23","2025-09-23","2025-11-06","2025-11-06","2025-12-02","2025-12-02","2025-12-02","2026-03-03","2025-12-02","2026-02-10","2026-03-03","2025-11-06","2025-11-06","2025-11-06","2025-07-23","2025-07-23","2025-07-23","2025-07-23","2026-04-09","2025-12-02","2026-03-03","2025-07-17","2025-09-23","2026-02-23","2026-04-09","2025-09-23","2026-01-22","2025-09-23","2025-09-05","2025-07-17","2025-11-19","2025-09-09","2025-09-09","2025-09-09","2025-12-02","2026-01-22","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2026-01-14","2026-02-10","2026-01-30","2026-03-03","2026-01-22","2026-01-22","2026-01-30","2026-01-30","2026-02-10","2026-01-30","2026-01-30","2026-03-02","2026-01-14","2026-01-14","2026-01-14","2026-02-18","2026-04-08","2026-03-03","2026-03-02","2026-03-03","2026-04-09","2026-04-09","2026-02-23","2026-02-23","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-03"],"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":[["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","CAPVAXIVE","0.5 ML","","Select","Select",""],["","","MECLIZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","5 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","100 MG","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","40 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","5 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","50 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","60 MG","","Select","Select",""],["","","VENLAFAXINE HCL","37.5 MG","","Select","Select",""],["","","BUSPIRONE HYDROCHLORIDE","30 MG","","Select","Select",""],["","","ONDANSETRON ODT","4 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","MIRTAZAPINE","7.5 MG","","Select","Select",""],["","","SCOPOLAMINE","1 MG","","Select","Select",""],["","","VENLAFAXINE HYDROCHLORIDE ER","","","Select","Select",""],["","","ABRYSVO","120 MCG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","Meclizine Tab","25 MG","","Select","Select",""],["","","Venlafaxine Tab","37.5 MG","","Select","Select",""],["","","Cephalexin Cap","500 MG","","Select","Select",""],["","","Mirtazapine Tab","7.5 MG","","Select","Select",""],["","","Fluzone Hd Inj 2025-26","","","Select","Select",""],["","","Olmesa Medox Tab","40 MG","","Select","Select",""],["","","Duloxetine Cap","60 MG","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Ondansetron Tab","4 MG","","Select","Select",""],["","","Scopolamine Dis","1 MG","","Select","Select",""],["","","Metformin Tab","500 MG","","Select","Select",""],["","","Buspirone Tab","30 MG","","Select","Select",""],["","","Losartan Pot Tab","100 MG","","Select","Select",""],["","","Venlafaxine Tab 37.5 Er","","","Select","Select",""],["","","Prochlorper Tab","5 MG","","Select","Select",""],["","","Metoprol Tar Tab","50 MG","","Select","Select",""],["","","Gabapentin Cap","100 MG","","Select","Select",""],["","","Hydrochlorot Tab","25 MG","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Capvaxive Inj","0.5 ML","","Select","Select",""],["","","Zolpidem Tab","5 MG","","Select","Select",""],["","","Trazodone Tab","50 MG","","Select","Select",""],["","","Abrysvo Inj","120 MCG","","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":""}]}]}