{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DYOLFSEMLOH","gend":0,"add":"IR 008TS EGD","city":"RICHMOND","state":"IN","zip":47374,"dob":"1947-07-18","age":"","mstatus":"","insh":"18014910344","cliId":"","pno":"3956758129","cno":"7659392185","email":"","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Reid","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","R002","I10","I480","Z7901","R000","R0602","R079","J329","H401132","H04123","H018","H18413","H25813","H401134","H11153","Z1331","K219","Z125","R5383","Z79899","R748","K8020","N281","I4819","I428","I5032","I351","I2510","R059","R051","I509","N400","I119","H9191","H401112","N390","I447","I429","Z01812","Z20822","R9439","H401131","I517","I361","I340","I083","N401","R350","H401121","K589","I48.91","R00.2","I48.0","Z79.01","R00.0","R06.02","R07.9","J32.9","H40.1132","H04.123","H01.8","H18.413","H25.813","H40.1134","H11.153","Z13.31","K21.9","Z12.5","R53.83","Z79.899","R74.8","K80.20","N28.1","I48.19","I42.8","I50.32","I35.1","I25.10","R05.9","R05.1","I50.9","N40.0","I11.9","H91.91","H40.1112","N39.0","I44.7","I42.9","Z01.812","Z20.822","R94.39","H40.1131","I51.7","I36.1","I34.0","I08.3","N40.1","R35.0","H40.1121","K58.9"],"date":["2022-11-01","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-09-28","2022-09-06","2022-09-06","2022-09-06","2022-09-06","2022-04-22","2022-04-22","2022-04-22","2022-04-05","2022-04-05","2022-03-21","2022-03-21","2022-03-21","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2021-12-21","2021-12-21","2021-12-20","2021-11-29","2021-11-29","2021-10-10","2021-08-23","2021-07-13","2021-05-26","2021-05-26","2021-04-27","2021-04-27","2021-04-16","2021-04-13","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-03-01","2021-01-12","2022-11-01","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-09-28","2022-09-06","2022-09-06","2022-09-06","2022-09-06","2022-04-22","2022-04-22","2022-04-22","2022-04-05","2022-04-05","2022-03-21","2022-03-21","2022-03-21","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2021-12-21","2021-12-21","2021-12-20","2021-11-29","2021-11-29","2021-10-10","2021-08-23","2021-07-13","2021-05-26","2021-05-26","2021-04-27","2021-04-27","2021-04-16","2021-04-13","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-03-01","2021-01-12"],"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":[["","","FUROSEMIDE","20","90","Select","Select",""],["","","LISINOPRIL","5","90","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0","90","Select","Select",""],["","","TRIAMTERENE\/HYDROCHLOROTHIAZIDE","0","90","Select","Select",""],["","","SOTALOL HYDROCHLORIDE","80","90","Select","Select",""],["","","TRAVOPROST","0","2","Select","Select",""],["","","ELIQUIS","5.000MG","180","Select","Select",""],["","","PROCTO-MED HC","2.00%","28","Select","Select",""],["","","PREVNAR 20","0","1","Select","Select",""],["","","SHINGRIX","50.000MCG\/0.5ML","1","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":""}]}]}