{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AICULALLIV","gend":1,"add":" KCOR 0172DR DNALSI","city":"EAST WENATCHEE","state":"WA","zip":98802,"dob":"1953-09-16","age":"","mstatus":"","insh":"22014910665","cliId":"","pno":"8890533416","cno":"5098861433","email":"","ename":"","eno":"","pphy":"KATHRYN EREN","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":"1629365598"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R011","F410","F4323","F331","G4709","Z23","R42","E119","G4733","Z1231","G4700","M48061","M5416","I10","E785","Z0000","M47816","Z981","G609","M79604","M79605","R200","M5126","Z0100","H5213","H0288A","H52203","M6289","E782","E118","Z0183","E559","Z780","M85039","R69","M810","R0602","Z961","I252","R0600","Z8249","F329","Z13220","S32010A","M961","J301","E1140","Z8701","U071","J1289","J9601","E1142","G4730","R918","E7800","Z20828","G43911","R01.1","F41.0","F43.23","F33.1","G47.09","E11.9","G47.33","Z12.31","G47.00","M48.061","M54.16","E78.5","Z00.00","M47.816","Z98.1","G60.9","M79.604","M79.605","R20.0","M51.26","Z01.00","H52.13","H02.88A","H52.203","M62.89","E78.2","E11.8","Z01.83","E55.9","Z78.0","M85.039","M81.0","R06.02","Z96.1","I25.2","R06.00","Z82.49","F32.9","Z13.220","S32.010A","M96.1","J30.1","E11.40","Z87.01","U07.1","J12.89","J96.01","E11.42","G47.30","01","R91.8","E78.00","Z20.828","G43.911"],"date":["2022-12-13","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-12-10","2022-11-22","2022-11-14","2022-10-29","2022-10-20","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-07-22","2022-06-29","2022-06-29","2022-06-29","2022-05-03","2022-05-03","2022-05-03","2021-12-06","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-10-27","2021-09-29","2021-09-29","2021-09-22","2021-09-22","2021-04-05","2021-04-05","2021-02-15","2021-02-09","2021-02-04","2021-01-27","2021-01-27","2021-01-08","2020-12-03","2020-10-08","2020-09-22","2020-09-22","2020-09-22","2020-09-14","2020-08-28","2020-08-28","2020-07-23","2020-07-23","2020-07-23","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-20","2020-05-06","2022-12-13","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-11-14","2022-10-29","2022-10-20","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-07-22","2022-06-29","2022-06-29","2022-06-29","2022-05-03","2022-05-03","2022-05-03","2021-12-06","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-10-27","2021-09-29","2021-09-29","2021-09-22","2021-09-22","2021-04-05","2021-04-05","2021-02-09","2021-02-04","2021-01-27","2021-01-27","2021-01-08","2020-12-03","2020-10-08","2020-09-22","2020-09-22","2020-09-22","2020-09-14","2020-08-28","2020-08-28","2020-07-23","2020-07-23","2020-07-23","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-20","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":[["","","NAPROXEN","500","60","Select","Select",""],["","","GABAPENTIN","300.000MG","810","Select","Select",""],["","","ATORVASTATIN CALCIUM","80.000MG","90","Select","Select",""],["","","LISINOPRIL","40.000MG","90","Select","Select",""],["","","OMEPRAZOLE","20.000MG","90","Select","Select",""],["","","ESCITALOPRAM OXALATE","10.000MG","60","Select","Select",""],["","","PROPRANOLOL HYDROCHLORIDE","10.000MG","90","Select","Select",""],["","","FLUOXETINE HYDROCHLORIDE","20.000MG","45","Select","Select",""],["","","NORTRIPTYLINE HYDROCHLORIDE","10.000MG","-90","Select","Select",""],["","","CLONAZEPAM","0.000MG","56","Select","Select",""],["","","DICLOFENAC SODIUM","1.00%","100","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","100","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":""}]}]}