{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELLEHCIMSSILLIW ","gend":1,"add":"DR3 213ES EVA ","city":"SOAP LAKE","state":"WA","zip":98851,"dob":"1953-03-07","age":"","mstatus":"","insh":"32114910642","cliId":"","pno":"7790568721","cno":"5097712786","email":"","ename":"","eno":"","pphy":"DEANNA SNYDER","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":"1952605479"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S46.912","N95.0","R062","R058","E119","Z794","E785","R32","K5903","R69","E6601","H2513","D3132","H524","R06.2","R05.8","E11.9","Z79.4","E78.5","K59.03","E66.01","H25.13","D31.32","H52.4"],"date":["2023-05-28","2023-04-25","2022-12-14","2022-12-14","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2022-04-07","2022-03-15","2022-03-09","2022-02-24","2022-02-24","2022-02-24","2022-12-14","2022-12-14","2022-07-14","2022-07-14","2022-07-14","2022-04-07","2022-03-09","2022-02-24","2022-02-24","2022-02-24"],"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":[["","","TIZANIDINE HCL","2.000MG","30","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25.000MG","90","Select","Select",""],["","","MYRBETRIQ","25.000MG","90","Select","Select",""],["","","OMEPRAZOLE","40.000MG","90","Select","Select",""],["","","ATORVASTATIN CALCIUM","20.000MG","90","Select","Select",""],["","","DICLOFENAC SODIUM DR","75.000MG","180","Select","Select",""],["","","LISINOPRIL","10.000MG","90","Select","Select",""],["","","VICTOZA","18.000MG\/3ML","18","Select","Select",""],["","","RELION PEN NEEDLES 31G X 6MM","0","100","Select","Select",""],["","","ALBUTEROL SULFATE HFA","108.000MCG\/ACT","18","Select","Select",""],["","","GLIPIZIDE","5.000MG","180","Select","Select",""],["","","BD PEN NEEDLE\/SHORT\/ULTRA-FINE\/31G X 8MM","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":""}]}]}