{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NAIRBLLEWES","gend":0,"add":"L W 503RD POO","city":"MOSES LAKE","state":"WA","zip":98837,"dob":"1956-11-09","age":"","mstatus":"","insh":"31114910898","cliId":"","pno":"5890556185","cno":"5098558165","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":"","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":["Z85.46","E11.9","Z79.4","E78.00","I10","E78.5","I48.92","E66.01","Z68.36","E03.9","G47.33","Z79.84","E1165","I4891","R002","E119","I4892","E6601","E7800","I480","I483","E1159","E118","Z7984","E785","D122","D124","Z86010","K5730","Z8546","E1169","E11.65","I48.91","R00.2","I48.0","I48.3","E11.59","E11.8","D12.2","D12.4","Z86.010","K57.30","E11.69"],"date":["2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2022-11-17","2022-11-16","2022-10-31","2022-10-19","2022-10-19","2022-10-19","2022-10-12","2022-10-11","2022-10-11","2022-10-11","2022-07-05","2022-07-05","2022-07-05","2022-05-10","2022-05-10","2022-05-10","2022-05-10","2022-04-04","2022-04-02","2022-11-17","2022-11-16","2022-10-31","2022-10-11","2022-10-11","2022-10-11","2022-07-05","2022-05-10","2022-05-10","2022-05-10","2022-05-10","2022-04-02"],"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":[["","","METOPROLOL TARTRATE","50","60","Select","Select",""],["","","FREESTYLE LANCETS","0","100","Select","Select",""],["","","ATORVASTATIN CALCIUM","20","30","Select","Select",""],["","","DIGOXIN","125","30","Select","Select",""],["","","PIOGLITAZONE HCL","45","30","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000","60","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","100","Select","Select",""],["","","ELIQUIS","5","60","Select","Select",""],["","","EASY TOUCH PEN NEEDLES 31GX1\/4\"","0","100","Select","Select",""],["","","VICTOZA","18.000MG\/3ML","9","Select","Select",""],["","","LEVOTHYROXINE SODIUM","75.000MCG","90","Select","Select",""],["","","PIOGLITAZONE HYDROCHLORIDE","45.000MG","30","Select","Select",""],["","","LISINOPRIL","5.000MG","30","Select","Select",""],["","","LANTUS SOLOSTAR","100.000UNIT\/ML","15","Select","Select",""],["","","TRADJENTA","5.000MG","30","Select","Select",""],["","","FREESTYLE LITE BLOOD GLUCOSE MONITORING SYSTEM","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":""}]}]}