{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA JOHNSON","gend":1,"currentgend":"","add":"614 Pine St","city":"Halstead","state":"KS","zip":"67056","dob":"1961-11-07","age":"","mstatus":"","insh":"K44013702","cliId":"","pno":"3163475606","cno":"3163475606","email":"wkj61@yahoo.com","ename":"","eno":"","pphy":"ASHLEY MILLER","ppno":"3169424519","pcpadd":"3715 N OLIVER ST","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67220-3404","pcpcounty":"","pcpid":"","pcpname":"ADVANCED PAIN MEDICINE ASSOC LLC","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"         ","pcpfaxno":"","pcpnpi":"1831642040","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44013702","medicareid":"1C06WN3AV74","medicaidid":"1C06WN3AV74","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","M069","G8929","G43909","R251","Z7984","Z79899","J342","J343","R0602","I2510","R600","Z7289","S81802A","L03116","M25562","G4700","Z760","Z79891","M25561","G43111","M47816","M8580","M21062","M5459","M25762","E1169","M25571","S21109A","Z1331","H35383","Z5181","E119","H25813","J9601","J449","M51362","N3281","J189","E875","R531","N3000","R6520","E785","K219","B961","Z66","Z7951","Z7982","Z955","R6884","M79602","I252","F17290"],"date":["2026-06-04","2026-06-04","2026-04-02","2026-01-12","2026-01-12","2026-06-12","2026-05-26","2026-01-15","2026-01-15","2026-06-04","2026-05-26","2026-06-04","2026-06-04","2026-02-16","2026-02-16","2026-06-01","2026-02-16","2026-02-16","2026-06-01","2026-02-18","2026-02-18","2026-06-01","2026-03-11","2026-02-25","2026-02-25","2026-02-25","2026-06-12","2026-04-02","2026-04-02","2026-04-02","2026-04-07","2026-04-07","2026-05-11","2026-04-22","2026-05-22","2026-06-12","2026-06-12","2026-06-12","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-26","2026-05-11","2026-05-26","2026-05-26","2026-05-26","2026-05-26"],"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":[["","","ESOMEPRAZOLE MAGNESIUM","40 MG","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","200 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","150 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","10 MG","","Select","Select",""],["","","DEXCOM G7 15 DAY SENSOR","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5 MG","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE","","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","25 MG","","Select","Select",""],["","","PRIMIDONE","50 MG","","Select","Select",""],["","","PREGABALIN","200 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","20 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50 MG","","Select","Select",""],["","","DIPHENOXYLATE HYDROCHLORIDE\/ATROPINE SULFATE","2.5 MG","","Select","Select",""],["","","ONDANSETRON HYDROCHLORIDE","4 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","MORPHINE SULFATE","30 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","60 MG","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","10 MG","","Select","Select",""],["","","JANUVIA","100 MG","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","GLIMEPIRIDE","1 MG","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","10 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE\/SALMETEROL DISKUS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","","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":""}]}]}