{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONALD C LOCKE JR","gend":0,"currentgend":"","add":"608 N Caqrdington","city":"Wichita","state":"KS","zip":"67212","age":"","mstatus":"","insh":"K44012269","cliId":"","pno":"4058024761","cno":"4058024761","email":"mygolf1869@gmail.com","ename":"","eno":"","pphy":"AMANDA BARRETT","ppno":"3166910249","pcpadd":"2707 E 21ST ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67214-2249","pcpcounty":"","pcpid":"","pcpname":"HERMES HEALTHCARE","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1295471605","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44012269","medicareid":"6QW1AH5CH02","medicaidid":"6QW1AH5CH02","pcpFlag":"","dob":"1954-10-01"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4714","I4891","I4820","I050","R5381","R0602","E669","M542","M5412","M47816","Z79891","B351","L84","I7091","E11628","R262","L609","Z9181","E1142","H43813","H3563","H4313","R2681","R531","E119","E6601","N179","M4800","N189","R4182","M79605","M6281","I5031","I2510","G4730","R609","I872","Z6842","Z952","Z7901","G4733","R942","E662","E1122","I5032","H903","H938X3","E1165","Z794","I10","E559","R2689","M5450","G8929","I3481","R600","G2581","E1140","Z882","Z7984"],"date":["2026-03-25","2026-03-25","2026-04-28","2026-03-12","2026-03-25","2026-03-25","2026-03-25","2026-04-28","2026-06-05","2026-04-28","2026-06-05","2026-05-04","2026-05-04","2026-05-04","2026-02-18","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-01","2026-05-01","2026-05-01","2026-02-24","2026-02-24","2026-03-09","2026-03-09","2026-03-04","2026-02-24","2026-03-04","2026-02-24","2026-04-27","2026-04-27","2026-03-09","2026-03-09","2026-03-09","2026-03-09","2026-03-09","2026-04-29","2026-03-09","2026-03-09","2026-04-28","2026-03-25","2026-04-29","2026-03-04","2026-03-25","2026-04-21","2026-04-21","2026-02-17","2026-04-28","2026-05-04","2026-05-29","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2026-02-24"],"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":[["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","AMITRIPTYLINE HYDROCHLORIDE","50 MG","","Select","Select",""],["","","METOLAZONE","2.5 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","BUMETANIDE","2 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500 MG","","Select","Select",""],["","","ABRYSVO","120 MCG","","Select","Select",""],["","","HUMALOG KWIKPEN","","","Select","Select",""],["","","TOUJEO MAX SOLOSTAR","","","Select","Select",""],["","","SHINGRIX","50\/0.5 ML","","Select","Select",""],["","","WARFARIN SODIUM","5 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","25 MG","","Select","Select",""],["","","PRIMIDONE","50 MG","","Select","Select",""],["","","OZEMPIC","2 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":""}]}]}