{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AICIRTAPNILKNARF","gend":1,"add":"NOSREME N 207101 TPA EVA ","city":"WENATCHEE","state":"WA","zip":98801,"dob":"1957-08-12","age":"","mstatus":"","insh":"71014910558","cliId":"","pno":"7690521970","cno":"5096707912","email":"","ename":"","eno":"","pphy":"KELLY GILLESPIE","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":"1427109974"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25118","E1142","E1169","E785","R0602","R0609","R9439","I2510","D509","H60391","R000","F411","Z1231","Z803","R0600","R931","I10","E669","K621","D132","D508","D128","Z7984","Z79899","K760","D649","R748","E119","B351","Z139","R69","L299","Z1211","J9811","J986","E1121","B852","Z20822","R059","R5383","Z0101","E113291","H25812","H18523","H3589","H53022","G4710","R0683","Z6836","M8589","Q969","R918","Z01818","M810","E782","Z471","Z96642","M8580","Z09","M1612","Z87891","K219","F419","Z01812","M1712","I25.118","E11.42","E11.69","E78.5","R06.02","R06.09","R94.39","I25.10","D50.9","H60.391","R00.0","F41.1","Z12.31","Z80.3","R06.00","R93.1","E66.9","K62.1","D13.2","D50.8","D12.8","Z79.84","Z79.899","K76.0","D64.9","R74.8","E11.9","B35.1","Z13.9","L29.9","Z12.11","J98.11","J98.6","E11.21","B85.2","Z20.822","R05.9","R53.83","Z01.01","E11.3291","H25.812","H18.523","H35.89","H53.022","G47.10","R06.83","Z68.36","M85.89","Q96.9","R91.8","Z01.818","M81.0","E78.2","Z47.1","Z96.642","M85.80","M16.12","Z87.891","K21.9","F41.9","Z01.812","M17.12"],"date":["2022-12-22","2022-12-22","2022-12-22","2022-12-22","2022-12-20","2022-12-19","2022-12-19","2022-12-19","2022-12-13","2022-12-09","2022-11-06","2022-10-27","2022-10-21","2022-10-21","2022-09-29","2022-09-29","2022-11-21","2022-09-23","2022-09-14","2022-09-14","2022-09-14","2022-09-14","2022-08-18","2022-08-18","2022-07-24","2022-06-23","2022-06-23","2022-06-21","2022-05-31","2022-05-31","2022-06-07","2022-04-05","2022-01-21","2022-01-21","2022-01-21","2022-01-18","2022-01-18","2021-10-22","2021-10-22","2021-10-22","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-05-11","2021-05-11","2021-05-11","2021-03-29","2021-03-19","2021-03-11","2021-03-10","2021-03-04","2021-02-05","2020-12-01","2020-12-01","2020-12-01","2020-10-26","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2020-10-02","2020-10-01","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2022-12-21","2022-12-22","2022-11-11","2022-12-02","2022-10-31","2022-10-31","2022-10-06","2022-10-06","2022-11-21","2023-01-18","2023-01-18","2022-09-26","2023-01-18","2022-09-27","2022-09-27","2022-08-10","2022-07-22","2022-09-02","2022-06-27","2022-06-07","2022-06-06","2022-04-11","2022-01-27","2022-02-03","2022-02-03","2022-04-07","2022-02-09","2021-11-05","2021-11-05","2021-11-05","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-05-24","2021-05-24","2021-05-24","2021-04-07","2021-03-24","2021-03-25","2021-03-15","2022-04-07","2022-04-07","2020-12-08","2020-12-08","2020-12-08","2020-10-14","2020-10-14","2022-04-07","2020-10-09","2021-12-14","2020-10-19"],"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":[["","","ATORVASTATIN CALCIUM","40","90","Select","Select",""],["","","OZEMPIC","2","3","Select","Select",""],["","","GLIPIZIDE","10.000MG","180","Select","Select",""],["","","CLOPIDOGREL","75.000MG","90","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","50","Select","Select",""],["","","PAROXETINE HYDROCHLORIDE","20.000MG","90","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500.000MG","180","Select","Select",""],["","","TECHLITE PEN NEEDLES\/32G X 4MM","0","100","Select","Select",""],["","","NITROGLYCERIN","0.000MG","25","Select","Select",""],["","","CIPROFLOXACIN\/DEXAMETHASONE","0","7","Select","Select",""],["","","FLUTICASONE PROPIONATE","50.000MCG\/ACT","48","Select","Select",""],["","","GAVILYTE-C","0","4000","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":""}]}]}