{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIL SEMAJDLEIFELT","gend":0,"add":"NOINU 6326DR YELLAV ","city":"CHELAN","state":"WA","zip":98816,"dob":"1946-05-05","age":"","mstatus":"","insh":"22014910873","cliId":"","pno":"8690525802","cno":"5096820852","email":"","ename":"","eno":"","pphy":"ROSS BROWN","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Okanogan","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1346623501"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","Z79.84","M99.01","G54.0","M99.02","M79.18","R69","F4321","R002","M9905","S336XXA","M9904","M2450","E785","I4519","I10","E119","R251","G459","Z125","M9901","M7912","M9903","M7918","Z7984","Z23","R591","H2513","H52223","H524","E1136","Z8673","F320","R739","F43.21","R00.2","M99.05","S33.6XXA","M99.04","M24.50","E78.5","I45.19","R25.1","G45.9","Z12.5","M79.12","M99.03","R59.1","H25.13","H52.223","H52.4","E11.36","Z86.73","F32.0","R73.9"],"date":["2023-06-19","2023-06-19","2023-05-30","2023-05-30","2023-05-30","2023-05-30","2023-05-11","2022-02-17","2022-01-14","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-11-05","2021-11-05","2022-07-21","2021-11-05","2021-07-26","2021-07-26","2021-05-11","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-03-09","2021-03-12","2021-02-10","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2020-11-12","2020-06-25","2020-06-25","2022-03-10","2022-01-21","2022-01-14","2022-01-14","2022-01-14","2022-01-14","2022-07-21","2021-11-15","2021-07-30","2022-07-21","2021-05-17","2021-05-18","2021-05-18","2021-02-12","2021-02-01","2021-02-01","2021-02-01","2022-07-21","2020-11-16","2020-06-29","2020-07-08"],"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":[["","","METFORMIN HYDROCHLORIDE ER","500.000MG","60","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10.000MG","90","Select","Select",""],["","","LISINOPRIL","20.000MG","90","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","0","14","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":""}]}]}