{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HTIDUJNOTPAHC","gend":1,"add":"OLF 3161ES TS AR","city":"EAST WENATCHEE","state":"WA","zip":98802,"dob":"1953-03-25","age":"","mstatus":"","insh":"81014910111","cliId":"","pno":"2490525151","cno":"5094215152","email":"","ename":"","eno":"","pphy":"MICHAEL ABBOTT","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":"1336179928"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0781","I10","L988","H5203","H52223","H524","L309","Z1211","D120","Z86010","J320","J3489","R0981","R040","B351","E039","M1711","F17210","Z23","Z0000","J449","D582","R69","D122","K5730","K760","K8020","R102","N3000","R07.81","L98.8","H52.03","H52.223","H52.4","L30.9","Z12.11","D12.0","Z86.010","J32.0","J34.89","R09.81","R04.0","B35.1","E03.9","M17.11","F17.210","Z00.00","J44.9","D58.2","D12.2","K57.30","K76.0","K80.20","R10.2","N30.00"],"date":["2022-12-13","2022-12-13","2022-12-13","2022-09-29","2022-09-29","2022-09-29","2022-08-24","2022-08-02","2022-08-02","2022-08-02","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-02","2022-06-02","2022-06-02","2022-04-20","2022-03-22","2022-02-25","2022-02-25","2022-02-25","2021-06-10","2021-04-29","2021-04-29","2021-03-09","2021-03-09","2021-03-09","2021-02-02","2022-12-13","2022-12-13","2022-09-29","2022-09-29","2022-09-29","2022-08-24","2022-08-02","2022-08-02","2022-08-02","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-02","2022-06-02","2022-06-02","2022-04-20","2022-02-25","2022-02-25","2022-02-25","2021-04-29","2021-04-29","2021-03-09","2021-03-09","2021-03-09","2021-02-02"],"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":[["","","AMLODIPINE BESYLATE","2.000MG","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","100.000MCG","90","Select","Select",""],["","","TRAMADOL HCL","50.000MG","18","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","0.00%","30","Select","Select",""],["","","BUDESONIDE","0.000MG\/2ML","60","Select","Select",""],["","","MUPIROCIN","2.00%","22","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":""}]}]}