{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY E SULLIVAN","gend":1,"currentgend":"","add":"341 S 3rd St","city":"Clearwater","state":"KS","zip":"67026","age":"","mstatus":"","insh":"K44012198","cliId":"","pno":"6205846795","cno":"6205846795","email":"sullivan@sktc.net","ename":"","eno":"","pphy":"KELLY FREUND","ppno":"3162606363","pcpadd":"7329 W VILLAGE CIR","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67205-1555","pcpcounty":"","pcpid":"","pcpname":"ICT INTERNAL MEDICINE AND PAIN MANAGEMENT LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"3162606301","pcpnpi":"1619248325","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44012198","medicareid":"8UA3HD2TN99","medicaidid":"8UA3HD2TN99","pcpFlag":"","dob":"1942-07-08"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z981","M47816","M130","Z79891","Z5181","H353222","H43813","E890","I10","E8352","E039","N2581","Z85850","M19012","M12812","S79812A","Z96642","D649","D631","I129","D472","M150","R760","M7062","M7061","M7051","M7052","M810","M3501","Z7952","G2581","M9973","R9431","E785","Z8249","I340","I351","N1831","R1319","H353231","H5203","H52223","H524","N6310","N6320","R92323"],"date":["2026-05-11","2026-02-16","2026-05-11","2026-05-11","2026-05-11","2026-02-11","2026-02-18","2026-04-20","2026-05-19","2026-04-27","2026-04-27","2026-04-27","2026-01-30","2026-03-02","2026-03-02","2026-03-02","2026-03-02","2026-01-06","2026-02-09","2026-02-09","2026-02-09","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2026-05-11","2026-05-19","2026-05-19","2026-05-19","2026-03-17","2026-03-17","2026-04-27","2026-05-01","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-04-16","2026-04-16","2026-04-16"],"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":[["","","PRAMIPEXOLE DIHYDROCHLORIDE","0.25 MG","","Select","Select",""],["","","PREDNISONE","2.5 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10 MEQ","","Select","Select",""],["","","CLONIDINE HYDROCHLORIDE","0.1 MG","","Select","Select",""],["","","ALENDRONATE SODIUM","70 MG","","Select","Select",""],["","","LATANOPROST","0.01%","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","112 MCG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","30 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","","","Select","Select",""],["","","SYNTHROID","125 MCG","","Select","Select",""],["","","CINACALCET HYDROCHLORIDE","30 MG","","Select","Select",""],["","","BRIMONIDINE TARTRATE","0.15%","","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":""}]}]}