{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" KNARFLEPMET","gend":0,"add":"AHS 34971SERCA YD","city":"EPHRATA","state":"WA","zip":98823,"dob":"1952-01-27","age":"","mstatus":"","insh":"42014910195","cliId":"","pno":"3290556317","cno":"5092371365","email":"","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.01","Z51.81","D68.69","I48.0","E11.69","E78.2","I10","M54.2","M25.511","R19.7","T38.3X5","Z79.84","Z12.11","Z7901","Z5181","I480","E1169","E782","Z23","Z0000","G4733","I5032","Z45018","I442","F909","F339","Z9989","E119","H524","Z7984","Z09","H25811","E1136","I4891","H25812","E785","F329","M5450","G8929","H25813","M9903","M5459","M9904","M9905","M5442","M4315","M5137","M47816","Z20822","M5451","M545","E1159","I441","Z9189","F331","F341","Z6831","N3943","N410","R399","J3489","R0989","Z20828","H52223","R42","Z00.00","G47.33","I50.32","Z45.018","I44.2","F90.9","F33.9","Z99.89","E11.9","H52.4","H25.811","E11.36","I48.91","H25.812","E78.5","F32.9","M54.50","G89.29","H25.813","M99.03","M54.59","M99.04","M99.05","M54.42","M43.15","M51.37","M47.816","Z20.822","M54.51","M54.5","E11.59","I44.1","Z91.89","F33.1","F34.1","Z68.31","N39.43","N41.0","R39.9","J34.89","R09.89","Z20.828","H52.223"],"date":["2023-06-21","2023-06-21","2023-06-21","2023-06-21","2023-05-26","2023-05-26","2023-05-26","2023-05-26","2023-05-26","2023-05-26","2023-05-26","2023-05-26","2023-04-25","2022-12-19","2022-12-19","2022-12-19","2022-11-14","2022-11-14","2022-10-24","2022-10-18","2022-09-22","2022-09-19","2022-09-16","2022-09-16","2022-08-24","2022-08-24","2022-08-02","2022-05-18","2022-05-18","2022-03-22","2022-02-18","2022-02-17","2022-02-17","2022-02-17","2022-01-27","2022-01-27","2022-01-27","2021-12-20","2021-12-20","2021-12-16","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-10-18","2021-10-11","2021-09-30","2021-07-28","2021-07-21","2021-07-21","2021-05-05","2021-05-05","2021-04-22","2021-03-08","2021-03-01","2021-02-12","2020-12-23","2020-12-23","2020-12-23","2020-10-20","2020-10-15","2022-10-18","2022-09-22","2022-09-19","2022-09-16","2022-09-16","2022-08-24","2022-08-24","2022-08-02","2022-05-18","2022-05-18","2022-02-17","2022-02-17","2022-02-17","2022-01-27","2022-01-27","2022-01-27","2021-12-20","2021-12-20","2021-12-16","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-10-18","2021-10-11","2021-09-30","2021-07-28","2021-07-21","2021-07-21","2021-05-05","2021-05-05","2021-04-22","2021-03-08","2021-03-01","2021-02-12","2020-12-23","2020-12-23","2020-12-23","2020-10-20"],"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":[["","","WARFARIN SODIUM","3","115","Select","Select",""],["","","MODAFINIL","200","90","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE","60.000MG","90","Select","Select",""],["","","BENAZEPRIL HCL","10.000MG","90","Select","Select",""],["","","ATORVASTATIN CALCIUM","80.000MG","90","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25.000MG","90","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","0.00%","473","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","12","Select","Select",""],["","","CLINDAMYCIN HCL","150.000MG","30","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50.000MG","180","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500.000MG","360","Select","Select",""],["","","FLOWFLEX COVID-19 ANTIGEN HOME TEST","0","8","Select","Select",""],["","","FLUZONE HIGH-DOSE PF 2022-2023","0","1","Select","Select",""],["","","AMPHETAMINE\/DEXTROAMPHETAMINE","0","30","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":""}]}]}