{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ADNILTTALF","gend":1,"add":"CNAF 7462GDNL REH","city":"EAST WENATCHEE","state":"WA","zip":98802,"dob":"1947-09-25","age":"","mstatus":"","insh":"12014910263","cliId":"","pno":"8890555456","cno":"5098865455","email":"","ename":"","eno":"","pphy":"JASON GROSDIDIER","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Douglas","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1972534832"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4821","Z7901","I480","I4811","E785","Z87891","R600","I4891","R609","E7800","E6601","Z6841","I10","R739","Z1211","D123","D124","Z86010","R69","Z1231","Z5181","R9431","Z23","Z20822","H524","H5203","H2513","H1013","I7789","H93A2","Z01812","H9193","H938X3","Z803","E669","I48.21","Z79.01","I48.0","I48.11","E78.5","Z87.891","R60.0","I48.91","R60.9","E78.00","E66.01","Z68.41","R73.9","Z12.11","D12.3","D12.4","Z86.010","Z12.31","Z51.81","R94.31","Z20.822","H52.4","H52.03","H25.13","H10.13","I77.89","H93.A2","Z01.812","H91.93","H93.8X3","Z80.3","E66.9"],"date":["2022-10-28","2022-10-28","2022-09-13","2022-09-09","2022-09-09","2022-09-09","2022-08-04","2022-08-04","2022-05-24","2022-05-11","2022-05-11","2022-05-11","2022-08-11","2022-05-09","2022-03-14","2022-03-14","2022-03-14","2022-03-14","2022-02-04","2022-01-12","2022-01-10","2022-01-03","2021-12-08","2021-05-11","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-04-15","2021-04-15","2021-04-13","2020-12-10","2020-12-10","2020-08-14","2020-07-09","2022-11-07","2022-11-07","2022-09-20","2022-09-15","2022-09-15","2022-09-15","2022-08-17","2022-08-17","2022-05-31","2022-08-11","2022-08-11","2022-05-20","2022-05-16","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-01-19","2022-01-19","2022-01-12","2021-05-24","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-08-05","2021-05-03","2021-04-29","2021-01-04","2020-12-17","2020-08-21","2020-07-17"],"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":[["","","BETAMETHASONE DIPROPIONATE","0","60","Select","Select",""],["","","ELIQUIS","5","180","Select","Select",""],["","","ATORVASTATIN CALCIUM","20.000MG","90","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50.000MG","270","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.00%","80","Select","Select",""],["","","FLUCONAZOLE","200.000MG","12","Select","Select",""],["","","KETOCONAZOLE","2.00%","120","Select","Select",""],["","","FLUZONE HIGH-DOSE PF 2022-2023","0","1","Select","Select",""],["","","DIGOXIN","125.000MCG","90","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":""}]}]}