{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HANIDSIWEL","gend":1,"add":"ISIVID S 3581 TPA TS NO","city":"MOSES LAKE","state":"WA","zip":98837,"dob":"1958-10-16","age":"","mstatus":"","insh":"11604910962","cliId":"","pno":"5790573400","cno":"5097500437","email":"","ename":"","eno":"","pphy":"PHILIP BUCKLEY","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Grant","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1720014947"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","H6122","M79671","E7800","Z720","Z23","F330","F17210","H401133","I69351","Z0101","H4089","H5203","H524","Z8673","F17200","Z79899","I69359","Z87891","F329","Z0100","R928","R748","Z1231","R7301","H6123","H61.22","M79.671","E78.00","Z72.0","F33.0","F17.210","H40.1133","I69.351","Z01.01","H40.89","H52.03","H52.4","Z86.73","F17.200","Z79.899","I69.359","Z87.891","F32.9","Z01.00","R92.8","R74.8","Z12.31","R73.01","H61.23"],"date":["2022-11-14","2022-11-14","2022-08-11","2022-08-11","2022-08-11","2022-08-04","2022-05-10","2022-05-10","2022-05-10","2022-05-10","2022-04-01","2022-04-01","2022-04-01","2022-04-01","2022-02-15","2022-01-17","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2020-11-11","2020-11-10","2020-10-28","2020-10-23","2020-10-22","2020-10-22","2022-11-14","2022-08-11","2022-08-11","2022-08-11","2022-05-10","2022-05-10","2022-05-10","2022-05-10","2022-04-01","2022-04-01","2022-04-01","2022-04-01","2022-02-15","2022-01-17","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2020-11-11","2020-11-10","2020-10-28","2020-10-23","2020-10-22","2020-10-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"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":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","SIMVASTATIN","10","-90","Select","Select",""],["","","AMLODIPINE BESYLATE","5","-90","Select","Select",""],["","","BRIMONIDINE TARTRATE","0","15","Select","Select",""],["","","DORZOLAMIDE HCL\/TIMOLOL MALEATE","0","-20","Select","Select",""],["","","LATANOPROST","0","7","Select","Select",""],["","","CITALOPRAM HYDROBROMIDE","20","90","Select","Select",""],["","","MELOXICAM","15","30","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20.000MEQ","60","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","0","120","Select","Select",""],["","","TRAMADOL HCL","50.000MG","18","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and 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":[]},{"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":[]}]},{"t":"Exam Review","q":[{"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":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"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":""}]}]}