{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H SEMAJREHCSLO","gend":0,"add":"AITNE 3388DR REVIR T","city":"ENTIAT","state":"WA","zip":98822,"dob":"1957-10-06","age":"","mstatus":"","insh":"81014910980","cliId":"","pno":"8790530024","cno":"5097842003","email":"","ename":"","eno":"","pphy":"MARY RIDGEWAY","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":"1477585875"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M62.9","G35","M54.50","G89.29","M43.10","M62.838","M54.59","M47.816","M51.36","N319","N400","M62838","M5459","G8929","R69","R5381","R5383","K4090","D176","F329","G839","Z85850","M5412","M5450","R252","M25562","N3941","M5020","M47812","R29898","M50223","M50321","R41841","R41844","M50121","M4312","Z1211","L570","L821","L119","S95801A","S90111A","S90112A","E039","G114","N401","R3915","M9901","M542","M9902","M546","N318","M6281","R296","F09","M25552","G8389","M47894","M4154","M25862","M25852","T8484XA","Z96652","Z8500","E890","M87851","G894","Z79891","M9905","M5451","M7918","M4186","M5386","M7062","M545","M160","R262","M79605","I82552","I82542","N3943","M7632","M87852","M25462","M7122","M879","Z86718","R600","I872","N31.9","N40.0","R53.81","R53.83","K40.90","D17.6","F32.9","G83.9","Z85.850","M54.12","R25.2","M25.562","N39.41","M50.20","M47.812","R29.898","M50.223","M50.321","R41.841","R41.844","M50.121","M43.12","Z12.11","L57.0","L82.1","L11.9","S95.801A","S90.111A","S90.112A","E03.9","G11.4","N40.1","R39.15","M99.01","M54.2","M99.02","M54.6","N31.8","M62.81","R29.6","M25.552","G83.89","M47.894","M41.54","M25.862","M25.852","T84.84XA","Z96.652","Z85.00","E89.0","M87.851","G89.4","Z79.891","M99.05","M54.51","M79.18","M41.86","M53.86","M70.62","M54.5","M16.0","R26.2","M79.605","I82.552","I82.542","N39.43","M76.32","M87.852","M25.462","M71.22","M87.9","Z86.718","R60.0","I87.2"],"date":["2023-06-23","2023-06-23","2023-06-13","2023-06-13","2023-05-25","2023-05-16","2023-05-16","2023-04-21","2023-04-21","2022-12-29","2022-12-29","2022-12-20","2022-12-20","2022-12-20","2022-12-01","2022-11-22","2022-11-22","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-20","2022-10-20","2022-10-20","2022-09-07","2022-08-19","2022-08-11","2022-05-18","2022-05-18","2022-05-18","2022-05-10","2022-05-10","2022-05-06","2022-05-06","2022-05-04","2022-05-04","2022-05-03","2022-04-18","2022-04-18","2022-04-18","2022-04-04","2022-04-04","2022-04-04","2022-02-16","2022-02-16","2022-01-26","2022-01-26","2022-01-14","2022-01-14","2022-01-14","2022-01-14","2022-01-10","2022-01-04","2022-01-04","2021-12-21","2021-12-21","2021-12-03","2021-12-03","2021-12-03","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2021-11-03","2021-11-02","2021-10-14","2021-10-08","2021-10-08","2021-10-07","2021-10-07","2021-09-01","2021-08-22","2021-08-22","2021-07-22","2021-07-03","2021-06-22","2021-06-03","2021-05-06","2021-04-23","2021-04-23","2021-02-22","2021-01-21","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2020-06-30","2020-06-30","2020-06-04","2022-12-29","2022-12-29","2022-11-22","2022-11-22","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-20","2022-10-20","2022-09-07","2022-08-19","2022-08-11","2022-05-18","2022-05-18","2022-05-18","2022-05-10","2022-05-10","2022-05-06","2022-05-06","2022-05-04","2022-05-04","2022-05-03","2022-04-18","2022-04-18","2022-04-18","2022-04-04","2022-04-04","2022-04-04","2022-02-16","2022-02-16","2022-01-26","2022-01-26","2022-01-14","2022-01-14","2022-01-14","2022-01-14","2022-01-10","2022-01-04","2022-01-04","2021-12-21","2021-12-03","2021-12-03","2021-12-03","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2021-11-03","2021-11-02","2021-10-14","2021-10-08","2021-10-08","2021-10-07","2021-10-07","2021-09-01","2021-08-22","2021-08-22","2021-07-22","2021-07-03","2021-06-22","2021-06-03","2021-05-06","2021-04-23","2021-04-23","2021-02-22","2021-01-21","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2020-06-30","2020-06-30","2020-06-04"],"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":[["","","BACLOFEN","10","180","Select","Select",""],["","","TRAMADOL HCL","50","120","Select","Select",""],["","","GABAPENTIN","300.000MG","180","Select","Select",""],["","","DICLOFENAC SODIUM DR","50.000MG","90","Select","Select",""],["","","TIZANIDINE HCL","2.000MG","360","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","0.000MG","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","150.000MCG","90","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50.000MG","120","Select","Select",""],["","","VENLAFAXINE HYDROCHLORIDE","37.000MG","84","Select","Select",""],["","","DULOXETINE HCL","30.000MG","60","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","2.000MG","-360","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5.000MG","12","Select","Select",""],["","","KESIMPTA","20.000MG\/0.4ML","-1","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":""}]}]}