{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ANOISSOV","gend":1,"add":"ORKA 6EVA N","city":"ROCK ISLAND","state":"WA","zip":98850,"dob":"1955-05-20","age":"","mstatus":"","insh":"61604910870","cliId":"","pno":"3490522083","cno":"5094338022","email":"","ename":"","eno":"","pphy":"ANTON GRASCH","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":"1124469127"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N83.9","G25.81","N83.291","N83.202","I10","Z0120","Z23","Z0000","N839","E538","F3342","M4120","Z1231","Z1159","F329","F341","R030","U071","R5383","R519","R059","Z20822","Z1211","D123","D125","Z800","N3000","Z803","D509","M8588","G2581","E785","R300","Z01.20","Z00.00","E53.8","F33.42","M41.20","Z12.31","Z11.59","F32.9","F34.1","R03.0","U07.1","R53.83","R51.9","R05.9","Z20.822","Z12.11","D12.3","D12.5","Z80.0","N30.00","Z80.3","D50.9","M85.88","E78.5","R30.0"],"date":["2023-06-07","2023-06-07","2023-05-31","2023-05-31","2022-11-02","2022-08-15","2022-08-10","2022-08-10","2022-06-12","2022-05-24","2022-05-06","2022-05-06","2022-03-16","2022-02-07","2022-02-07","2022-01-12","2022-01-12","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-02","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-01-21","2021-01-18","2021-01-04","2020-10-09","2020-09-30","2020-09-30","2020-07-15","2022-08-15","2022-08-10","2022-05-24","2022-05-06","2022-05-06","2022-03-16","2022-02-07","2022-02-07","2022-01-12","2022-01-12","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-02","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-01-21","2021-01-18","2021-01-04","2020-10-09","2020-09-30","2020-07-15"],"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":[["","","AMLODIPINE BESYLATE","10.000MG","90","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (SR)","150.000MG","87","Select","Select",""],["","","SERTRALINE HCL","50.000MG","87","Select","Select",""],["","","LOSARTAN POTASSIUM","100.000MG","90","Select","Select",""],["","","ROPINIROLE HYDROCHLORIDE","0.000MG","30","Select","Select",""],["","","FLULAVAL QUADRIVALENT 2022-2023","0","1","Select","Select",""],["","","MODERNA COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","50.000MCG\/0.5ML","1","Select","Select",""],["","","FLUCELVAX QUADRIVALENT 2022-2023","0","-1","Select","Select",""],["","","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","0","90","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":""}]}]}