{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AC NODEGNON","gend":0,"add":"TSEW 5018EVA KOORB","city":"YAKIMA","state":"WA","zip":98908,"dob":"1946-05-17","age":"","mstatus":"","insh":"56904910124","cliId":"","pno":"2490528526","cno":"5094262582","email":"","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Signal","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","Z95.2","Z952","Z7901","Z23","E119","E785","I10","I723","Z0000","Q87418","N200","N401","N5203","R9720","I729","G8929","M5450","R140","Q8740","R229","M545","E781","R69","Z87442","R310","H524","H52223","H5203","N131","N138","Z466","N201","N135","Z1159","E11.9","E78.5","I72.3","Z00.00","Q87.418","N20.0","N40.1","N52.03","R97.20","I72.9","G89.29","M54.50","R14.0","Q87.40","R22.9","M54.5","E78.1","Z87.442","R31.0","H52.4","H52.223","H52.03","N13.1","N13.8","Z46.6","N20.1","N13.5","Z11.59"],"date":["2023-06-17","2023-06-17","2022-12-25","2022-12-25","2022-10-05","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-05-23","2022-05-23","2022-03-14","2022-03-14","2022-03-14","2022-01-11","2021-11-10","2021-11-10","2021-11-10","2021-07-14","2021-06-09","2021-05-19","2021-05-19","2021-05-11","2021-03-31","2021-02-23","2021-01-18","2020-11-25","2020-11-25","2020-11-25","2020-07-14","2020-07-14","2020-07-14","2020-06-08","2020-06-08","2020-06-05","2022-07-07","2022-07-07","2022-07-07","2022-05-23","2022-05-23","2022-03-14","2022-03-14","2022-03-14","2022-01-11","2021-11-10","2021-11-10","2021-11-10","2021-07-14","2021-06-09","2021-05-19","2021-05-19","2021-05-11","2021-02-23","2021-01-18","2020-11-25","2020-11-25","2020-11-25","2020-07-14","2020-07-14","2020-07-14","2020-06-08","2020-06-08","2020-06-05"],"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":[["","","ACCU-CHEK SOFTCLIX LANCETS","0","100","Select","Select",""],["","","LISINOPRIL","10","90","Select","Select",""],["","","BD PEN NEEDLE\/SHORT\/ULTRA-FINE\/31G X 8MM","0","100","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000","180","Select","Select",""],["","","FENOFIBRIC ACID DR","135","90","Select","Select",""],["","","LANTUS SOLOSTAR","100","60","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50.000MG","180","Select","Select",""],["","","FINASTERIDE","5.000MG","77","Select","Select",""],["","","AMOXICILLIN","500.000MG","12","Select","Select",""],["","","ATORVASTATIN CALCIUM","40.000MG","90","Select","Select",""],["","","WARFARIN SODIUM","5.000MG","90","Select","Select",""],["","","ALLOPURINOL","300.000MG","60","Select","Select",""],["","","FREESTYLE LANCETS","0","100","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","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":""}]}]}