{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R ARBEDSTREBO","gend":1,"add":"HT6 643WS EVA ","city":"EPHRATA","state":"WA","zip":98823,"dob":"1953-01-23","age":"","mstatus":"","insh":"22114910940","cliId":"","pno":"8290570609","cno":"5092890607","email":"","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","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":["E11.40","Z79.4","Z79.84","M47812","M50322","G959","M4802","I6523","H47093","H25813","H35372","E1151","E1122","N186","N1830","M6281","R292","E1142","E1121","Z794","E782","K219","N3000","R5383","G7100","I129","N1832","E1165","G729","E785","E1159","I10","E2839","R1310","R1314","R1313","R0609","Z20822","Z1231","E1149","N184","M47.812","M50.322","G95.9","M48.02","I65.23","H47.093","H25.813","H35.372","E11.51","E11.22","N18.6","N18.30","M62.81","R29.2","E11.42","E11.21","E78.2","K21.9","N30.00","R53.83","G71.00","I12.9","N18.32","E11.65","G72.9","E78.5","E11.59","E28.39","R13.10","R13.14","R13.13","R06.09","Z20.822","Z12.31","E11.49","N18.4"],"date":["2023-06-09","2023-06-09","2023-06-09","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-07","2022-12-07","2022-12-07","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-10-27","2022-10-27","2022-09-29","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2022-09-06","2022-09-06","2022-09-06","2022-08-17","2022-08-17","2022-08-17","2022-08-04","2022-07-26","2022-07-26","2022-07-18","2022-05-12","2022-04-11","2022-04-11","2022-03-24","2022-03-17","2022-03-15","2022-01-25","2022-01-13","2022-01-12","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2022-12-07","2022-12-07","2022-12-07","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-10-27","2022-10-27","2022-09-29","2022-09-08","2022-09-08","2022-09-08","2022-09-06","2022-09-06","2022-09-06","2022-08-17","2022-08-17","2022-08-17","2022-08-04","2022-07-26","2022-07-26","2022-05-12","2022-04-11","2022-04-11","2022-03-24","2022-03-17","2022-03-15","2022-01-25","2022-01-13","2022-01-12"],"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":[["","","LISINOPRIL","40","30","Select","Select",""],["","","TRAMADOL HCL","50","90","Select","Select",""],["","","PREGABALIN","50","60","Select","Select",""],["","","LANTUS SOLOSTAR","100","15","Select","Select",""],["","","FUROSEMIDE","20.000MG","90","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500.000MG","180","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50.000MG","90","Select","Select",""],["","","ATORVASTATIN CALCIUM","40.000MG","90","Select","Select",""],["","","LOSARTAN POTASSIUM","50.000MG","90","Select","Select",""],["","","DROPLET PEN NEEDLES 32GX8MM","0","300","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5.000MG","15","Select","Select",""],["","","METHOCARBAMOL","750.000MG","40","Select","Select",""],["","","HUMALOG KWIKPEN","100.000UNIT\/ML","45","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","300","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100.000MG","14","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":""}]}]}