{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DLAREGYELNIF","gend":0,"add":"IL 612NL CAL","city":"MOXEE","state":"WA","zip":98936,"dob":"1939-04-04","age":"","mstatus":"","insh":"19904910997","cliId":"","pno":"5490562887","cno":"5094578826","email":"","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Signal","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":["L57.0","D485","R58","L538","L570","L720","Z0000","E1129","I10","E782","Z7689","L821","L814","L559","Z08","L578","Z85828","I788","L859","B001","E119","L218","E781","E790","Z483","S01302A","C44219","R609","R059","R0602","S51802A","R0981","M25561","M25562","E785","J449","R040","J342","J343","L711","C4441","C44629","N400","H02035","D48.5","L53.8","L72.0","Z00.00","E11.29","E78.2","Z76.89","L82.1","L81.4","L55.9","L57.8","Z85.828","I78.8","L85.9","B00.1","E11.9","L21.8","E78.1","E79.0","Z48.3","S01.302A","C44.219","R60.9","R05.9","R06.02","S51.802A","R09.81","M25.561","M25.562","E78.5","J44.9","R04.0","J34.2","J34.3","L71.1","C44.41","C44.629","N40.0","H02.035"],"date":["2023-06-15","2022-11-09","2022-11-15","2022-11-09","2022-11-09","2022-11-09","2022-08-12","2022-08-12","2022-09-07","2022-08-12","2022-07-29","2022-07-21","2022-07-21","2022-07-21","2022-07-26","2022-04-25","2022-04-25","2022-03-09","2022-02-17","2022-02-01","2022-02-01","2022-01-19","2021-12-28","2021-12-28","2021-12-02","2021-11-23","2021-11-23","2021-11-09","2021-11-09","2021-11-09","2021-10-05","2021-10-05","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-05-05","2021-03-11","2021-03-11","2021-03-11","2021-02-16","2021-01-25","2020-09-16","2020-08-14","2022-11-15","2022-11-15","2022-11-30","2022-09-07","2022-09-07","2022-09-07","2022-08-05","2022-07-26","2022-07-26","2022-07-26","2022-04-29","2022-04-29","2022-03-14","2022-03-11","2022-02-21","2022-06-29","2022-01-24","2022-01-18","2022-01-18","2021-12-06","2021-11-26","2021-11-26","2021-11-18","2021-11-18","2021-11-16","2022-10-17","2022-10-17","2021-08-19","2021-08-19","2022-11-10","2022-11-10","2021-05-17","2021-04-06","2021-04-06","2021-04-06","2021-02-19","2021-02-08","2020-10-05","2020-08-20"],"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":[["","","LISINOPRIL","40","90","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25.000MG","90","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.000MG","180","Select","Select",""],["","","PFIZER-BIONTECH COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","30.000MCG\/0.3ML","0","Select","Select",""],["","","METOPROLOL SUCCINATE ER","100.000MG","90","Select","Select",""],["","","ALLOPURINOL","100.000MG","180","Select","Select",""],["","","VALACYCLOVIR HCL","1.000GM","12","Select","Select",""],["","","FLUZONE HIGH-DOSE PF 2022-2023","0","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":""}]}]}