{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLADNARSIEHT ","gend":0,"add":"OP 611DR EUG","city":"OMAK","state":"WA","zip":98841,"dob":"1952-01-05","age":"","mstatus":"","insh":"77014910406","cliId":"","pno":"5590527797","cno":"5095579772","email":"","ename":"","eno":"","pphy":"TONI WALLER","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Okanogan","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1144867649"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","G4733","E785","I10","R3129","D8989","R058","Z79899","R69","M9901","M5030","M9902","M5134","E039","Z131","R799","Z7189","Z760","Z0100","H40053","H538","H2513","Z9989","H5213","H52203","Z8616","E78.5","R31.29","D89.89","R05.8","Z79.899","M99.01","M50.30","M99.02","M51.34","E03.9","Z13.1","R79.9","Z71.89","Z76.0","Z01.00","H40.053","H53.8","H25.13","Z99.89","H52.13","H52.203","Z86.16"],"date":["2023-05-30","2022-12-30","2022-12-23","2022-12-23","2022-12-19","2022-10-31","2022-10-31","2022-10-31","2022-09-13","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-18","2021-03-18","2021-03-18","2021-02-12","2022-12-23","2022-12-19","2022-10-31","2022-10-31","2022-10-31","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-18","2021-03-18","2021-03-18","2021-02-12"],"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":[["","","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","0","30","Select","Select",""],["","","ATORVASTATIN CALCIUM","20.000MG","90","Select","Select",""],["","","AMLODIPINE BESYLATE","5.000MG","90","Select","Select",""],["","","AMOXICILLIN","500.000MG","14","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","0","-30","Select","Select",""],["","","LOSARTAN POTASSIUM","50.000MG","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":""}]}]}