{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ECNERWALLEKIEH ","gend":0,"add":"OH 0451NL YLL","city":"EAST WENATCHEE","state":"WA","zip":98802,"dob":"1953-01-24","age":"","mstatus":"","insh":"79014910000","cliId":"","pno":"7690533170","cno":"5096707133","email":"","ename":"","eno":"","pphy":"DANIEL PUGMIRE","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Chelan","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1578853784"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","R69","I10","I71.21","E78.5","G4733","R079","R931","R001","I358","J9811","I77810","I421","Z01812","Z1211","R0789","E785","U071","Z1159","R9431","Z0001","I517","Z0000","Z9989","H6981","H6122","G4761","Z20822","Z01818","R07.9","R93.1","R00.1","I35.8","J98.11","I77.810","I42.1","Z01.812","Z12.11","R07.89","U07.1","Z11.59","R94.31","Z00.01","I51.7","Z00.00","Z99.89","H69.81","H61.22","G47.61","Z20.822","Z01.818"],"date":["2023-06-06","2023-06-06","2023-06-01","2023-06-01","2023-06-01","2022-12-10","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-14","2022-10-04","2022-08-22","2022-08-22","2022-08-03","2022-06-20","2022-04-25","2022-04-05","2022-04-05","2022-04-04","2021-11-01","2021-08-08","2021-08-08","2021-06-01","2021-05-12","2021-05-12","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-14","2022-10-04","2022-08-22","2022-08-03","2022-06-20","2022-04-25","2022-04-05","2022-04-05","2022-04-04","2021-11-01","2021-08-08","2021-08-08","2021-06-01","2021-05-12","2021-05-12"],"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":[["","","TRAZODONE HYDROCHLORIDE","50","45","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","0","90","Select","Select",""],["","","ROSUVASTATIN CALCIUM","20","90","Select","Select",""],["","","SPIRONOLACTONE","25.000MG","90","Select","Select",""],["","","PFIZER-BIONTECH COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","30.000MCG\/0.3ML","1","Select","Select",""],["","","FLUZONE HIGH-DOSE PF 2022-2023","0","1","Select","Select",""],["","","PAXLOVID","0","30","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":""}]}]}