{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S NAMYLRELOOHC","gend":0,"add":"DLOG 502TS TSERC","city":"EAST WENATCHEE","state":"WA","zip":98802,"dob":"1952-01-08","age":"","mstatus":"","insh":"18904910479","cliId":"","pno":"8890525334","cno":"5098843352","email":"","ename":"","eno":"","pphy":"MICHAEL FADICH","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Chelan","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1447256433"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R63.4","R918","E871","R634","J432","Z136","I77811","I723","Z87891","Z0000","F3342","I10","U099","U071","I129","N189","F17210","J029","R5383","R059","F17200","G44019","F3341","G44001","F22","H40003","Z125","H2513","D3132","H5203","E119","E079","G43919","I2510","I252","J449","J439","Z1329","R91.8","E87.1","J43.2","Z13.6","I77.811","I72.3","Z87.891","Z00.00","F33.42","U09.9","U07.1","I12.9","N18.9","F17.210","J02.9","R53.83","R05.9","F17.200","G44.019","F33.41","G44.001","H40.003","Z12.5","H25.13","D31.32","H52.03","E11.9","E07.9","G43.919","I25.10","I25.2","J44.9","J43.9","Z13.29"],"date":["2023-04-19","2022-10-22","2022-10-22","2022-10-22","2022-10-22","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-08-31","2022-03-08","2022-03-08","2021-08-30","2021-08-30","2021-05-05","2021-03-11","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2020-06-18","2020-05-06","2022-10-22","2022-10-22","2022-10-22","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-11","2022-10-11","2022-10-11","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-08-31","2022-03-08","2022-03-08","2021-08-30","2021-05-05","2021-03-11","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2020-06-18","2020-05-06"],"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":[["","","ATENOLOL","100","22","Select","Select",""],["","","BUTALBITAL\/ASPIRIN\/CAFFEINE\/CODEINE","0","120","Select","Select",""],["","","GAVILYTE-C","0","4000","Select","Select",""],["","","FLUARIX QUADRIVALENT 2022-2023","0","1","Select","Select",""],["","","PFIZER-BIONTECH COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","30.000MCG\/0.3ML","1","Select","Select",""],["","","PAXLOVID","0","30","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":""}]}]}