{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YLREVEBSTTIP ","gend":1,"add":"HT6 523WS EVA ","city":"EPHRATA","state":"WA","zip":98823,"dob":"1938-10-27","age":"","mstatus":"","insh":"71014910109","cliId":"","pno":"5790543924","cno":"5097542934","email":"","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","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":["R79.89","E87.1","A41.9","N39.0","I12.9","N18.31","R41.82","I10","E11.9","Z87.891","Z1231","Z803","Z0000","Z139","E118","H2513","E119","H524","Z794","E1140","E785","F0150","R69","E109","R413","E1122","E1159","E781","F0390","E1121","I129","N1831","E1141","M5416","Z7984","E139","N630","Z12.31","Z80.3","Z00.00","Z13.9","E11.8","H25.13","H52.4","Z79.4","E11.40","E78.5","F01.50","E10.9","R41.3","E11.22","E11.59","E78.1","F03.90","E11.21","E11.41","M54.16","Z79.84","E13.9","N63.0"],"date":["2023-06-01","2023-06-01","2023-06-01","2023-06-01","2023-05-25","2023-05-25","2023-05-24","2023-06-12","2023-05-24","2023-05-24","2022-11-18","2022-11-18","2022-10-20","2022-10-20","2022-10-18","2022-10-17","2022-10-17","2022-10-17","2022-09-09","2022-09-03","2022-09-03","2022-09-03","2022-04-14","2022-02-25","2022-02-25","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-06-21","2021-06-21","2021-06-21","2021-06-10","2021-06-10","2021-06-10","2020-12-18","2020-10-09","2023-01-27","2022-12-14","2023-01-27","2023-01-27","2022-11-01","2022-10-20","2022-10-20","2022-09-19","2023-06-12","2023-06-12","2023-06-12","2022-03-09","2022-03-09","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2021-06-30","2022-08-12","2021-06-18","2022-08-12","2020-12-28","2021-06-22"],"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":[["","","LANTUS SOLOSTAR","100","15","Select","Select",""],["","","LISINOPRIL","10","90","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","100","Select","Select",""],["","","ATENOLOL","50.000MG","180","Select","Select",""],["","","BD PEN NEEDLE\/MINI\/ULTRA-FINE\/31G X 5MM","0","-100","Select","Select",""],["","","ATORVASTATIN CALCIUM","80.000MG","45","Select","Select",""],["","","CEFUROXIME AXETIL","250.000MG","14","Select","Select",""],["","","MEMANTINE HYDROCHLORIDE","5.000MG","180","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000.000MG","180","Select","Select",""],["","","GABAPENTIN","300.000MG","180","Select","Select",""],["","","MODERNA COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","50.000MCG\/0.5ML","0","Select","Select",""],["","","FLUZONE HIGH-DOSE PF 2022-2023","0","1","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":""}]}]}