{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ADNILYELGIH","gend":1,"add":"LIH 306RD POTL","city":"EPHRATA","state":"WA","zip":98823,"dob":"1952-08-20","age":"","mstatus":"","insh":"33014910005","cliId":"","pno":"5790530364","cno":"5097546303","email":"","ename":"","eno":"","pphy":"JENNIFER PIMENTEL-JAHNS","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":"1497041024"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","Z63.79","E11.21","Z79.84","M17.9","M16.9","C50.111","Z17.0","Z79.811","Z78.0","M17.11","M17.0","C50011","Z170","Z79811","M1712","M170","E6601","Z6841","Z0000","Z1159","H47393","Z0101","H5203","E119","E1121","I10","M1711","M25561","Z7984","F331","Z780","E2839","C50911","Z7189","C773","J45909","M1990","M47819","Z4889","Z98890","G4730","C50811","D689","J449","Z20822","C50919","Z9011","Z23","Z6842","D0501","N6315","C50111","K219","R928","N6311","N6313","N6341","I2510","F329","K3189","T39395D","Z0100","H35361","E1136","Z1211","E669","C44319","D485","Z1231","M25462","C50.011","M17.12","E66.01","Z68.41","Z00.00","Z11.59","H47.393","Z01.01","H52.03","E11.9","M25.561","E28.39","C50.911","Z71.89","C77.3","J45.909","M19.90","M47.819","Z48.89","Z98.890","G47.30","C50.811","D68.9","J44.9","Z20.822","C50.919","Z90.11","Z68.42","D05.01","N63.15","K21.9","R92.8","N63.11","N63.13","N63.41","I25.10","F32.9","K31.89","T39.395D","Z01.00","H35.361","E11.36","Z12.11","E66.9","C44.319","D48.5","Z12.31","M25.462"],"date":["2023-06-07","2023-06-07","2023-06-07","2023-06-07","2023-06-07","2023-06-07","2023-06-06","2023-06-06","2023-06-06","2023-05-30","2023-05-19","2023-05-19","2022-11-22","2022-11-22","2022-11-22","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-09-28","2022-09-28","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-13","2022-09-13","2022-09-12","2022-09-12","2022-09-09","2022-09-09","2022-05-31","2022-05-31","2022-03-22","2022-03-22","2022-03-01","2022-01-07","2022-01-05","2022-01-05","2021-12-20","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-06","2021-11-12","2021-11-02","2021-10-20","2021-10-20","2021-09-21","2021-09-21","2021-09-17","2021-09-17","2021-08-31","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-04-02","2021-03-12","2021-03-12","2020-10-15","2020-10-15","2020-10-15","2020-09-08","2020-09-08","2020-09-03","2020-08-27","2020-08-14","2020-07-20","2022-11-22","2022-11-21","2022-11-21","2022-11-21","2022-09-28","2022-09-28","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-12","2022-05-31","2022-03-22","2022-03-22","2022-03-01","2022-01-07","2022-01-05","2022-01-05","2021-12-20","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-06","2021-11-12","2021-11-02","2021-10-20","2021-09-21","2021-09-21","2021-09-17","2021-08-31","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-04-02","2021-03-12","2021-03-12","2020-10-15","2020-10-15","2020-10-15","2020-09-08","2020-09-08","2020-09-03","2020-08-27","2020-08-14","2020-07-20"],"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","360","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4","30","Select","Select",""],["","","GABAPENTIN","300","900","Select","Select",""],["","","SERTRALINE HYDROCHLORIDE","100","90","Select","Select",""],["","","LOVASTATIN","40.000MG","180","Select","Select",""],["","","MELOXICAM","15.000MG","90","Select","Select",""],["","","GLIPIZIDE ER","10.000MG","90","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","40","Select","Select",""],["","","LETROZOLE","2.000MG","90","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","300.000MG","28","Select","Select",""],["","","LISINOPRIL","40.000MG","90","Select","Select",""],["","","PANTOPRAZOLE SODIUM","20.000MG","90","Select","Select",""],["","","ALBUTEROL SULFATE HFA","108.000MCG\/ACT","8","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","50","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":""}]}]}