{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUAN D MENDEZ SR","gend":0,"currentgend":"","add":"1928 S Martinson St","city":"Wichita","state":"KS","zip":"67213","dob":"1957-12-21","age":"","mstatus":"","insh":"K44013137","cliId":"","pno":"3166504312","cno":"3166504312","email":"jmendezsr1@gmail.com","ename":"","eno":"","pphy":"LISA LE","ppno":"3166609768","pcpadd":"8533 E 32ND ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67214-3127","pcpcounty":"","pcpid":"","pcpname":"UKSM-WICHITA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1720015449","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44013137","medicareid":"3D01VQ4HA20","medicaidid":"3D01VQ4HA20","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I1310","E1122","N189","R0609","R9431","E785","G4733","R600","R079","Z9189","I10","E119","Z23","Z1331","Z0000","I517","E7849","I872","I87311","I739","Z6834","Z716","E669","R0683","I5032"],"date":["2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2025-12-04","2026-02-05","2026-02-05","2025-12-04","2025-12-04","2026-05-07","2026-03-19","2026-01-08","2026-01-08","2026-01-27","2026-01-29","2026-02-05","2026-04-23","2026-04-10","2026-04-10","2026-04-10","2026-04-02","2026-05-07","2026-05-07","2026-05-07"],"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":[["","","FARXIGA","10 MG","","Select","Select",""],["","","LORAZEPAM","1 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","DAPAGLIFLOZIN PROPANEDIOL","10 MG","","Select","Select",""],["","","GLYBURIDE","5 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","750 MG","","Select","Select",""],["","","SIMVASTATIN","80 MG","","Select","Select",""],["","","RYBELSUS","3 MG","","Select","Select",""],["","","DAPAGLIFLOZIN","10 MG","","Select","Select",""],["","","ACCU-CHEK SOFTCLIX LANCETS","","","Select","Select",""],["","","ACCU-CHEK GUIDE","","","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":""}]}]}