{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B AILUJLLETRA","gend":1,"add":"HOJ E 919EVA NOSN","city":"CHELAN","state":"WA","zip":98816,"dob":"1945-12-10","age":"","mstatus":"","insh":"81014910382","cliId":"","pno":"8890503228","cno":"5098882230","email":"","ename":"","eno":"","pphy":"TOBE HARBERD","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":"1629158019"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.21","I10","M19.90","E66.3","Z68.29","E119","E669","E785","E1165","Z7984","E1122","N1830","H5203","H524","H52223","Z09","E875","H6991","Z0000","Z6834","Z23","H26493","H04123","Z961","E1121","M1990","G4700","H40053","U071","R69","J9601","E8342","R0602","B348","E11.9","E66.9","E78.5","E11.65","Z79.84","E11.22","N18.30","H52.03","H52.4","H52.223","E87.5","H69.91","Z00.00","Z68.34","H26.493","H04.123","Z96.1","G47.00","H40.053","U07.1","J96.01","E83.42","R06.02","B34.8"],"date":["2023-05-30","2023-05-30","2023-05-30","2023-05-30","2023-05-30","2022-12-02","2022-12-02","2022-12-02","2022-11-22","2022-11-22","2022-09-15","2022-09-15","2022-09-06","2022-09-06","2022-09-06","2022-09-06","2022-08-09","2022-08-09","2022-06-29","2022-06-29","2022-06-29","2022-04-26","2022-04-26","2022-04-26","2022-04-20","2022-03-18","2021-12-09","2021-02-18","2021-01-26","2021-01-07","2020-12-11","2020-12-11","2020-12-10","2020-12-10","2022-12-02","2022-12-02","2022-12-02","2022-11-22","2022-11-22","2022-09-15","2022-09-15","2022-09-06","2022-09-06","2022-09-06","2022-08-09","2022-08-09","2022-06-29","2022-06-29","2022-04-26","2022-04-26","2022-04-26","2021-12-09","2021-02-18","2021-01-26","2020-12-11","2020-12-11","2020-12-10","2020-12-10"],"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":[["","","RYBELSUS","14","30","Select","Select",""],["","","GLIPIZIDE","10.000MG","180","Select","Select",""],["","","GABAPENTIN","300.000MG","180","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","21","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500.000MG","360","Select","Select",""],["","","ATORVASTATIN CALCIUM","20.000MG","90","Select","Select",""],["","","METOPROLOL TARTRATE","100.000MG","180","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25.000MG","90","Select","Select",""],["","","LISINOPRIL","40.000MG","90","Select","Select",""],["","","AMLODIPINE BESYLATE","10.000MG","90","Select","Select",""],["","","GLIPIZIDE ER","10.000MG","90","Select","Select",""],["","","FLUTICASONE PROPIONATE","50.000MCG\/ACT","16","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":""}]}]}