{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HTIDUJDLOFNEP","gend":1,"add":"IRTTIKCM 7031D2 TPA TS KC","city":"WENATCHEE","state":"WA","zip":98801,"dob":"1951-08-29","age":"","mstatus":"","insh":"56014910773","cliId":"","pno":"6890566860","cno":"5098606866","email":"","ename":"","eno":"","pphy":"CASEY WYATT","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":"1134403678"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R73.9","R23.1","K52.81","E86.0","I45.81","I47.1","I44.4","R11.2","R19.7","I48.92","D72.829","E11.65","I10","E03.9","E78.5","G47.33","R25.9","E11.331","E11.329","Z79.84","Z09","K52.9","K29.40","R1013","R197","D509","E039","Z1211","K219","Z0130","Z0101","H40013","E113311","E113292","N1830","E1122","Z794","E1165","Z4889","M65341","M7061","M7062","M7631","M7632","R259","R2681","M160","E7800","F3289","G43909","I129","E113293","D631","M25551","M25552","E11311","H269","M1612","Z23","H2513","E1136","H5203","Z7984","N1832","E1121","Z87891","E113399","F329","Z4802","D04122","L989","E1129","D649","E785","R10.13","D50.9","Z12.11","K21.9","Z01.30","Z01.01","H40.013","E11.3311","E11.3292","N18.30","E11.22","Z79.4","Z48.89","M65.341","M70.61","M70.62","M76.31","M76.32","R26.81","M16.0","E78.00","F32.89","G43.909","I12.9","E11.3293","D63.1","M25.551","M25.552","E11.311","H26.9","M16.12","H25.13","E11.36","H52.03","N18.32","E11.21","Z87.891","E11.3399","F32.9","Z48.02","D04.122","L98.9","E11.29","D64.9"],"date":["2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-05","2023-05-30","2023-05-30","2023-05-30","2023-04-20","2023-02-06","2023-02-06","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-19","2022-12-19","2022-12-19","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-07-12","2022-06-29","2022-06-28","2022-06-28","2022-06-28","2022-06-28","2022-06-03","2022-06-03","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-03-25","2022-03-25","2022-03-03","2022-03-03","2022-03-03","2021-11-11","2021-11-11","2021-11-11","2021-10-29","2021-08-04","2021-08-04","2021-07-14","2021-07-14","2021-03-30","2021-03-30","2021-03-26","2021-03-26","2021-03-26","2020-10-27","2020-10-22","2020-10-08","2020-09-14","2020-09-14","2020-09-10","2023-01-05","2023-01-05","2022-12-22","2022-12-22","2022-12-22","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-10-24","2022-10-24","2022-10-24","2022-07-25","2022-07-06","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-06-08","2022-04-08","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-04-01","2022-03-11","2022-03-11","2022-03-11","2022-03-03","2022-03-03","2022-03-03","2021-08-12","2022-08-11","2021-07-20","2022-08-11","2021-04-12","2021-04-05","2022-04-06","2022-04-06","2020-11-02","2020-11-02","2020-10-26","2020-09-23","2020-11-14"],"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":[["","","TRESIBA FLEXTOUCH","200","27","Select","Select",""],["","","JANUVIA","100","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","137","90","Select","Select",""],["","","CITALOPRAM HYDROBROMIDE","10","60","Select","Select",""],["","","BD PEN NEEDLE\/SHORT\/ULTRA-FINE\/31G X 8MM","0","100","Select","Select",""],["","","TECHLITE PEN NEEDLES\/31G X 8MM","0","-100","Select","Select",""],["","","SURE COMFORT PEN NEEDLES 31GX5\/16\" (8MM)","0","-100","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40.000MG","90","Select","Select",""],["","","ATORVASTATIN CALCIUM","40.000MG","90","Select","Select",""],["","","PREDNISOLONE ACETATE","1.00%","10","Select","Select",""],["","","KETOROLAC TROMETHAMINE","0.00%","10","Select","Select",""],["","","DOXEPIN HYDROCHLORIDE","25.000MG","90","Select","Select",""],["","","LISINOPRIL","30.000MG","90","Select","Select",""],["","","TRULICITY","1.000MG\/0.5ML","6","Select","Select",""],["","","SUTAB","0","24","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500.000MG","180","Select","Select",""],["","","DICYCLOMINE HYDROCHLORIDE","20.000MG","120","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","-300","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":""}]}]}