{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" INOTEPOH","gend":1,"add":"T51 616EN TS H","city":"EAST WENATCHEE","state":"WA","zip":98802,"dob":"1947-01-15","age":"","mstatus":"","insh":"86704910722","cliId":"","pno":"9290574913","cno":"5092931947","email":"","ename":"","eno":"","pphy":"SARA NORRIS","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":"1104188598"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E03.9","R22.1","R41.3","I48.20","F33.0","I71.21","Z79.01","Z51.81","D68.69","Z0000","R0981","R413","F339","Z23","Z7901","I4820","Z5181","H47011","H2513","R69","E782","R591","E039","G4733","G43909","Z1231","Z0101","H5213","H52203","I480","E785","I712","R481","F1190","J3489","R011","G8918","M25569","Z96651","R262","Z471","R9431","I4519","R002","K5900","M1711","G4730","Z20822","Z01810","Z01818","R0609","R0602","Z1211","Z86010","D123","K635","Z1212","R42","M238X1","J309","R030","Z803","I4510","I2510","M797","I4891","R350","K219","F329","I482","Z00.00","R09.81","F33.9","H47.011","H25.13","E78.2","R59.1","G47.33","G43.909","Z12.31","Z01.01","H52.13","H52.203","I48.0","E78.5","I71.2","R48.1","F11.90","J34.89","R01.1","G89.18","M25.569","Z96.651","R26.2","Z47.1","R94.31","I45.19","R00.2","K59.00","M17.11","G47.30","Z20.822","Z01.810","Z01.818","R06.09","R06.02","Z12.11","Z86.010","D12.3","K63.5","Z12.12","M23.8X1","J30.9","R03.0","Z80.3","I45.10","I25.10","M79.7","I48.91","R35.0","K21.9","F32.9","I48.2"],"date":["2023-06-16","2023-06-16","2023-06-16","2023-06-16","2023-06-16","2023-06-16","2023-06-16","2023-06-09","2023-06-09","2023-06-09","2022-12-16","2022-12-16","2022-12-16","2022-12-16","2022-12-16","2022-12-13","2022-12-13","2022-12-13","2022-11-04","2022-11-04","2022-10-04","2022-09-30","2022-09-30","2022-09-30","2022-09-21","2022-09-09","2022-03-25","2021-10-29","2021-10-29","2021-10-29","2021-10-01","2021-08-12","2021-08-12","2021-05-21","2021-05-10","2021-05-10","2021-05-10","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-04-22","2021-04-02","2021-03-19","2021-03-18","2021-03-18","2021-03-11","2021-03-10","2021-03-09","2021-03-08","2021-03-01","2021-02-26","2021-02-17","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-01-08","2020-12-16","2020-12-07","2020-12-07","2020-12-07","2020-11-16","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2020-03-13","2020-03-13","2019-05-17","2022-12-16","2022-12-16","2022-12-16","2022-11-04","2022-11-04","2022-09-30","2022-09-30","2022-09-21","2022-09-09","2022-03-25","2021-10-29","2021-10-29","2021-10-29","2021-10-01","2021-08-12","2021-08-12","2021-05-21","2021-05-10","2021-05-10","2021-05-10","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-04-22","2021-04-02","2021-03-19","2021-03-18","2021-03-18","2021-03-11","2021-03-10","2021-03-09","2021-03-08","2021-03-01","2021-02-26","2021-02-17","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-01-08","2020-12-07","2020-12-07","2020-12-07","2020-11-16","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2020-03-13","2020-03-13","2019-05-17"],"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":[["","","PRAVASTATIN SODIUM","40","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","50","90","Select","Select",""],["","","LOSARTAN POTASSIUM","25","180","Select","Select",""],["","","TOPIRAMATE","25","180","Select","Select",""],["","","METOPROLOL TARTRATE","25.000MG","180","Select","Select",""],["","","WARFARIN SODIUM","5.000MG","100","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","0.00%","473","Select","Select",""],["","","AMOXICILLIN","500.000MG","15","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5.000MG","18","Select","Select",""],["","","FLUTICASONE PROPIONATE","50.000MCG\/ACT","16","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","25.000MG","9","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":""}]}]}