{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OD ANNAEDENIUQREIZ","gend":1,"add":"IPMAT E 061DR KRAP OC","city":"YAKIMA","state":"WA","zip":98903,"dob":"1944-09-12","age":"","mstatus":"","insh":"67904910961","cliId":"","pno":"7590518835","cno":"5095753881","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":["R05.3","R07.9","M25.551","M25.552","R91.8","F43.9","R53.83","R53.81","E03.9","S86091D","M25572","R262","M25551","M7661","M7662","S86021D","S4991XD","R296","S20211A","S40011A","S46911A","W010XXA","S4991XA","S299XXA","E039","E876","G8929","J449","Z79899","Z0000","K219","K312","Z9089","K9589","K9509","K311","Z9884","R112","R12","K310","K3189","K921","Z01818","R0602","R058","R1110","I2720","H5213","H04123","H43393","H903","R05","R918","M533","Z79891","Z5181","F439","M1610","J189","Z20822","Z9842","F419","F411","H1045","S86011D","M25571","M25471","R2689","J188","Z09","J9601","J45909","Z20828","S86011A","M797","M810","S86.091D","M25.572","R26.2","M76.61","M76.62","S86.021D","S49.91XD","R29.6","S20.211A","S40.011A","S46.911A","W01.0XXA","S49.91XA","S29.9XXA","E87.6","G89.29","J44.9","Z79.899","Z00.00","K21.9","K31.2","Z90.89","K95.89","K95.09","K31.1","Z98.84","R11.2","K31.0","K31.89","K92.1","Z01.818","R06.02","R05.8","R11.10","I27.20","H52.13","H04.123","H43.393","H90.3","M53.3","Z79.891","Z51.81","M16.10","J18.9","Z20.822","Z98.42","F41.9","F41.1","H10.45","S86.011D","M25.571","M25.471","R26.89","J18.8","J96.01","J45.909","Z20.828","S86.011A","M79.7","M81.0"],"date":["2023-05-19","2023-05-19","2023-05-19","2023-05-19","2023-05-19","2023-04-21","2023-04-21","2023-04-21","2023-04-21","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-11","2022-10-11","2022-10-11","2022-07-07","2022-07-07","2022-06-20","2022-06-20","2022-06-20","2022-06-20","2022-06-20","2022-06-20","2022-05-05","2022-05-05","2022-05-05","2022-05-05","2022-04-22","2022-04-22","2022-01-24","2022-01-24","2022-01-24","2022-01-17","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-21","2022-01-13","2022-01-13","2022-01-13","2022-01-10","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-09-08","2021-07-22","2021-06-30","2021-04-29","2021-04-29","2021-04-29","2021-03-01","2021-02-26","2021-02-26","2021-02-09","2021-02-09","2021-01-28","2020-10-08","2020-09-01","2020-07-29","2020-07-29","2020-07-29","2020-06-22","2020-07-02","2020-06-08","2020-06-08","2020-06-08","2020-04-15","2020-04-15","2020-04-15","2022-12-30","2022-12-30","2022-12-30","2022-10-26","2022-10-26","2022-10-26","2022-07-22","2022-07-22","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-24","2022-06-24","2022-05-24","2022-05-24","2022-06-16","2022-05-31","2022-05-31","2022-02-02","2022-02-02","2022-02-02","2022-01-26","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-01-21","2022-01-21","2022-01-21","2022-01-20","2021-11-16","2022-04-06","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-18","2021-07-23","2021-05-18","2021-05-18","2021-04-13","2021-03-05","2021-03-05","2021-05-03","2021-05-03","2021-04-06","2020-10-26","2020-09-04","2020-07-31","2020-07-31","2020-07-31","2020-06-29","2020-07-13","2020-07-13","2020-07-13","2020-09-22","2020-09-22","2020-09-22"],"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":[["","","SERTRALINE HCL","25","30","Select","Select",""],["","","BUSPIRONE HCL","15","120","Select","Select",""],["","","ALBUTEROL SULFATE","0.00%","360","Select","Select",""],["","","TRAMADOL HCL","50.000MG","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","75.000MCG","90","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100.000MG","14","Select","Select",""],["","","AZITHROMYCIN","250.000MG","6","Select","Select",""],["","","OMEPRAZOLE DR","10.000MG","-30","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE","100.000MG","-10","Select","Select",""],["","","FLUAD QUADRIVALENT 2022-2023","0","1","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5.000MG","42","Select","Select",""],["","","DICLOFENAC SODIUM","1.00%","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":""}]}]}