{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ALLETSEW","gend":1,"add":"B E 1071EVA RRU","city":"MOSES LAKE","state":"WA","zip":98837,"dob":"1942-07-20","age":"","mstatus":"","insh":"28704910337","cliId":"","pno":"7790553271","cno":"5097717235","email":"","ename":"","eno":"","pphy":"LUTHER THOMPSON","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Grant","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"SPACE #48","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1790915486"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M11.80","M15.9","I12.9","G25.81","F43.10","F41.0","E78.5","E88.81","K21.9","N39.41","F51.02","K74.3","E8881","I10","R519","F4310","L439","Z85828","L578","L570","L820","Z0000","M8589","Z9181","Z23","R69","M3501","N3941","R350","L309","M5450","G8929","I129","Z1152","R0602","R5383","M1180","M25532","R600","M25432","R110","M19032","M7989","E119","R053","F329","M3500","Z1231","Z803","Z66","S61431A","N1831","N1830","K743","L821","H04123","Z20822","M19049","Z79899","M25561","Z96653","Z96652","Z09","H918X3","H903","H9313","L299","Z5189","G2581","K219","F410","E785","G5790","E782","H6123","Z0100","H5203","H2513","H52203","R439","R510","R0981","M7910","Z4802","D1722","M1712","Z96642","Z471","Z96651","M21372","R569","E669","Z1159","Z01810","Z01818","N183","R7301","K869","R51.9","L43.9","Z85.828","L57.8","L57.0","L82.0","Z00.00","M85.89","Z91.81","M35.01","R35.0","L30.9","M54.50","G89.29","Z11.52","R06.02","R53.83","M25.532","R60.0","M25.432","R11.0","M19.032","M79.89","E11.9","R05.3","F32.9","M35.00","Z12.31","Z80.3","S61.431A","N18.31","N18.30","L82.1","H04.123","Z20.822","M19.049","Z79.899","M25.561","Z96.653","Z96.652","H91.8X3","H90.3","H93.13","L29.9","Z51.89","G57.90","E78.2","H61.23","Z01.00","H52.03","H25.13","H52.203","R43.9","R51.0","R09.81","M79.10","Z48.02","D17.22","M17.12","Z96.642","Z47.1","Z96.651","M21.372","R56.9","E66.9","01","Z11.59","Z01.810","Z01.818","N18.3","R73.01","K86.9"],"date":["2023-06-06","2023-06-06","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-08-19","2022-06-07","2022-05-19","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-04-22","2022-04-22","2022-04-22","2022-04-18","2022-04-11","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-24","2022-03-24","2022-03-24","2022-01-18","2022-01-18","2021-11-23","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-10-26","2021-10-06","2021-08-03","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-05-13","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-11","2021-05-11","2021-03-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-03","2020-11-27","2020-09-30","2020-09-30","2020-08-28","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-14","2020-07-27","2020-07-24","2020-07-14","2020-07-14","2019-06-06","2022-11-15","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-27","2022-09-27","2022-09-27","2022-06-07","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-04-22","2022-04-22","2022-04-22","2022-04-11","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-24","2022-03-24","2022-03-24","2022-01-18","2022-01-18","2021-11-11","2021-11-11","2021-11-11","2021-10-26","2021-10-06","2021-08-03","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-05-13","2021-05-11","2021-05-11","2021-03-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-03","2020-11-27","2020-09-30","2020-09-30","2020-08-28","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-14","2020-07-27","2020-07-24","2020-07-14","2020-07-14","2019-06-06"],"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":[["","","AMLODIPINE BESYLATE","2","90","Select","Select",""],["","","CLONAZEPAM","0","30","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","0","473","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5","12","Select","Select",""],["","","URSODIOL","300","90","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","20","Select","Select",""],["","","AZITHROMYCIN","250.000MG","6","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25.000MG","90","Select","Select",""],["","","PENICILLIN V POTASSIUM","500.000MG","40","Select","Select",""],["","","COLCHICINE","0.000MG","90","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","2.000MG","40","Select","Select",""],["","","OMEPRAZOLE","20.000MG","180","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50.000MG","270","Select","Select",""],["","","FAMOTIDINE","20.000MG","180","Select","Select",""],["","","DICLOFENAC SODIUM","1.00%","100","Select","Select",""],["","","DESVENLAFAXINE ER","50.000MG","90","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","5.000MG","270","Select","Select",""],["","","PILOCARPINE HYDROCHLORIDE","5.000MG","360","Select","Select",""],["","","TIZANIDINE HCL","2.000MG","40","Select","Select",""],["","","PAXLOVID","0","20","Select","Select",""],["","","MODERNA COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","50.000MCG\/0.5ML","1","Select","Select",""],["","","FLUOCINONIDE","0.00%","60","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":""}]}]}