{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HTURSSOR","gend":1,"add":"EHCTIP 8271DR NOYNAC R","city":"WENATCHEE","state":"WA","zip":98801,"dob":"1941-08-18","age":"","mstatus":"","insh":"34904910954","cliId":"","pno":"6290530814","cno":"5092641803","email":"","ename":"","eno":"","pphy":"NICOLE LINN","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Chelan","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1912294513"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R69","Z48.89","G56.01","G30.1","F02.80","E78.5","N18.9","K21.9","E03.9","G30.9","E210","N1831","E7800","E039","F5104","M25562","L570","E8352","M1120","J029","Z0000","Z0101","H04123","H25813","H3589","L820","K219","Z780","M1A0720","S92352A","M84375D","M79672","T148XXA","N1830","E038","Z20828","N183","E785","N289","G43009","E21.0","N18.31","E78.00","F51.04","M25.562","L57.0","E83.52","M11.20","J02.9","Z00.00","Z01.01","H04.123","H25.813","H35.89","L82.0","Z78.0","M1A.0720","S92.352A","M84.375D","M79.672","T14.8XXA","N18.30","E03.8","Z20.828","N18.3","N28.9","G43.009"],"date":["2023-06-01","2023-06-15","2023-06-02","2023-06-02","2023-06-02","2023-06-02","2023-06-02","2023-06-02","2023-06-02","2023-06-02","2022-11-14","2022-11-14","2022-11-14","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-10-05","2022-10-05","2022-08-29","2022-08-01","2022-02-28","2022-02-28","2022-02-28","2022-02-28","2021-12-15","2021-12-07","2021-12-01","2021-08-11","2021-06-17","2021-05-10","2021-05-10","2021-04-19","2021-01-07","2020-11-23","2020-11-05","2020-09-17","2020-09-17","2020-09-14","2020-03-09","2022-11-14","2022-11-14","2022-11-14","2022-11-01","2022-11-01","2022-11-01","2022-10-05","2022-10-05","2022-08-29","2022-08-01","2022-02-28","2022-02-28","2022-02-28","2022-02-28","2021-12-15","2021-12-01","2021-08-11","2021-06-17","2021-05-10","2021-05-10","2021-04-19","2021-01-07","2020-11-23","2020-11-05","2020-09-17","2020-09-14","2020-03-09"],"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":[["","","ALLOPURINOL","300","90","Select","Select",""],["","","ZOLPIDEM TARTRATE","10","30","Select","Select",""],["","","FAMOTIDINE","20","90","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5.000MG","5","Select","Select",""],["","","LEVOTHYROXINE SODIUM","150.000MCG","90","Select","Select",""],["","","OMEPRAZOLE","20.000MG","90","Select","Select",""],["","","ATORVASTATIN CALCIUM","40.000MG","45","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50.000MG","30","Select","Select",""],["","","PREDNISONE","20.000MG","7","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":""}]}]}