{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONI K FARRELL","gend":1,"currentgend":"","add":"3020 W Wildwood Ln","city":"Wichita","state":"KS","zip":"67217","age":"","mstatus":"","insh":"K44011420","cliId":"","pno":"3169270335","cno":"","email":"","ename":"","eno":"","pphy":"JENNIFER EDISON","ppno":"3165585950","pcpadd":"231 S ANDOVER RD","pcpcity":"ANDOVER","pcpstate":"KS","pcpzip":"67060-1471","pcpcounty":"","pcpid":"","pcpname":"XPRESSWELLNESS","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1578776001","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44011420","medicareid":"7UW0G15NY25","medicaidid":"7UW0G15NY25","pcpFlag":"","dob":"1960-06-15"},{"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":["N390","L84","B351","G608","R262","H5213","N760","R7303","Z13220","E039","I10","Z1321","N3281","R0609","M7989","G64","Z9189","M5450","M25551","R151","R152","M25562","M25552","M47812","G4710","F419","F32A","E6601","M25561","J320","R2681","Z6843","E079","I340","R002","E669","R413","R0789","R9439"],"date":["2025-09-10","2026-05-18","2026-05-18","2026-05-18","2026-06-19","2025-08-28","2025-10-02","2026-02-04","2025-12-03","2026-02-04","2026-05-22","2025-12-03","2026-02-04","2026-01-15","2026-01-15","2026-01-05","2026-05-22","2026-03-10","2026-05-01","2026-05-01","2026-05-01","2026-06-19","2026-04-30","2026-01-05","2026-04-23","2026-04-23","2026-04-23","2026-05-12","2026-06-04","2026-05-12","2026-05-12","2026-05-12","2026-05-12","2026-05-22","2026-05-22","2026-06-04","2026-02-04","2026-05-04","2026-05-06"],"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":[["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","5 MG","","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","ESTRADIOL","0.01%","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","300 MCG","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE PHOSPHATE","30 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","2.5 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","Levothyroxin Tab","300 MCG","","Select","Select",""],["","","Estradiol Cre 0.01%","","","Select","Select",""],["","","Fluconazole Tab","150 MG","","Select","Select",""],["","","Oxybutynin Tab","5 MG","","Select","Select",""],["","","Sertraline Tab","100 MG","","Select","Select",""],["","","Gabapentin Cap","300 MG","","Select","Select",""],["","","Lisinop\/Hctz Tab 20-12.5","","","Select","Select",""],["","","Pantoprazole Tab","40 MG","","Select","Select",""],["","","Nitrofurantn Cap","100 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":""}]}]}