{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" OIROGERGODRAJAUG","gend":0,"add":" EKAL PAOS 62111 TPA WN YAW","city":"SOAP LAKE","state":"WA","zip":98851,"dob":"1956-10-06","age":"","mstatus":"","insh":"70114910387","cliId":"","pno":"7790502491","cno":"5097719420","email":"","ename":"","eno":"","pphy":"JASON GROSDIDIER","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Douglas","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1972534832"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R062","K649","I480","L989","R195","K644","K648","Z7901","K922","Z5181","R051","J029","R0982","M9903","M47816","M9905","M47818","K219","E042","I10","Z0000","E6601","I495","L821","L03116","S91332A","B351","Z125","R739","E7800","Z23","R06.2","K64.9","I48.0","L98.9","R19.5","K64.4","K64.8","Z79.01","K92.2","Z51.81","R05.1","J02.9","R09.82","M99.03","M47.816","M99.05","M47.818","K21.9","E04.2","Z00.00","E66.01","I49.5","L82.1","L03.116","S91.332A","B35.1","Z12.5","R73.9","E78.00"],"date":["2022-12-30","2022-12-19","2022-12-19","2022-12-19","2022-12-16","2022-12-16","2022-12-16","2022-12-16","2022-12-16","2022-12-14","2022-11-16","2022-11-16","2022-11-16","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-07-13","2022-07-01","2022-07-06","2022-07-01","2022-07-01","2022-07-01","2022-04-21","2022-04-06","2022-03-24","2022-03-24","2022-02-16","2022-02-16","2022-02-16","2022-02-21","2023-01-09","2023-01-06","2023-01-06","2023-01-06","2022-12-22","2022-12-22","2022-12-22","2022-12-27","2022-12-27","2022-12-27","2022-11-25","2022-11-25","2022-11-25","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2022-07-18","2022-07-06","2022-07-14","2022-07-14","2022-07-14","2022-06-10","2022-04-26","2022-04-22","2022-04-22","2022-02-21","2022-02-21","2022-02-22"],"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":[["","","ELIQUIS","5","180","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","0","14","Select","Select",""],["","","PAXLOVID","0","30","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50","90","Select","Select",""],["","","AZITHROMYCIN","250","6","Select","Select",""],["","","SHINGRIX","50.000MCG\/0.5ML","1","Select","Select",""],["","","AMLODIPINE BESYLATE","10.000MG","90","Select","Select",""],["","","CHLORTHALIDONE","25.000MG","90","Select","Select",""],["","","HYDROCORTISONE","2.00%","28","Select","Select",""],["","","OMEPRAZOLE","20.000MG","90","Select","Select",""],["","","ATORVASTATIN CALCIUM","80.000MG","90","Select","Select",""],["","","LOSARTAN POTASSIUM","100.000MG","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","125.000MCG","90","Select","Select",""],["","","ALBUTEROL SULFATE HFA","108.000MCG\/ACT","8","Select","Select",""],["","","XARELTO","20.000MG","90","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","0","10","Select","Select",""],["","","WARFARIN SODIUM","5.000MG","230","Select","Select",""],["","","FLUTICASONE PROPIONATE","50.000MCG\/ACT","16","Select","Select",""],["","","PREDNISONE","20.000MG","5","Select","Select",""],["","","EUTHYROX","125.000MCG","90","Select","Select",""],["","","SUCRALFATE","1.000GM","120","Select","Select",""],["","","ONDANSETRON ODT","4.000MG","20","Select","Select",""],["","","TERBINAFINE HCL","250.000MG","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":""}]}]}