{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" IDUJNANAH","gend":1,"add":"HC 9101TS YRRE","city":"WENATCHEE","state":"WA","zip":98801,"dob":"1951-11-07","age":"","mstatus":"","insh":"86904910524","cliId":"","pno":"6690584843","cno":"5096634848","email":"","ename":"","eno":"","pphy":"RUSSELL HAVLICEK","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":"1861423741"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.50","M54.2","K621","Z8371","Z86010","Z980","M8588","H6121","M1612","Z1231","R69","M2550","M79672","R29898","S92155D","Z0101","H52223","H524","H2513","S93602A","S92155A","M7989","W108XXA","N951","K640","Z01411","Z90710","E039","D509","I10","K8000","Z1152","K8020","M25511","M5412","M21611","F419","E890","F329","F410","F411","Z20828","K828","K582","M1990","R12","M47812","R1011","K8050","E0590","R1013","D72829","R7401","R112","M546","R1110","R918","M4312","M2578","M4802","M50221","F40240","M542","G8929","Z1211","L309","E782","H25813","H04123","H43813","M7662","M898X1","G43909","M19011","F339","N3946","F438","N393","Z79890","G44209","M25562","M25462","H18463","H5203","G4700","U071","Z5181","K62.1","Z83.71","Z86.010","Z98.0","M85.88","H61.21","M16.12","Z12.31","M25.50","M79.672","R29.898","S92.155D","Z01.01","H52.223","H52.4","H25.13","S93.602A","S92.155A","M79.89","W10.8XXA","N95.1","K64.0","Z01.411","Z90.710","E03.9","D50.9","K80.00","Z11.52","K80.20","M25.511","M54.12","M21.611","F41.9","E89.0","F32.9","F41.0","F41.1","Z20.828","K82.8","K58.2","M19.90","M47.812","R10.11","K80.50","E05.90","R10.13","D72.829","R74.01","R11.2","M54.6","R11.10","R91.8","M43.12","M25.78","M48.02","M50.221","F40.240","G89.29","Z12.11","L30.9","E78.2","H25.813","H04.123","H43.813","M76.62","M89.8X1","G43.909","M19.011","F33.9","N39.46","F43.8","N39.3","Z79.890","G44.209","M25.562","M25.462","H18.463","H52.03","G47.00","U07.1","Z51.81"],"date":["2023-06-05","2023-03-01","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-03","2022-09-23","2022-09-21","2022-09-13","2022-09-07","2022-08-31","2022-08-31","2022-08-31","2022-08-22","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-06-02","2022-06-02","2022-06-02","2022-04-12","2022-04-11","2022-04-11","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-02-04","2022-01-25","2022-01-07","2022-01-07","2022-01-07","2021-11-09","2021-10-19","2021-10-12","2021-10-12","2021-10-09","2021-10-09","2021-10-09","2021-10-09","2021-10-07","2021-10-07","2021-10-07","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-09-28","2021-08-30","2021-08-30","2021-08-19","2021-08-11","2021-08-02","2021-07-30","2021-07-30","2021-07-30","2021-05-26","2021-03-26","2021-03-26","2021-03-22","2021-02-09","2021-01-14","2020-12-16","2020-10-08","2020-10-08","2020-09-28","2020-08-07","2020-08-07","2020-07-28","2020-07-28","2020-07-22","2020-07-09","2020-06-01","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-03","2022-09-23","2022-09-21","2022-09-13","2022-08-31","2022-08-31","2022-08-31","2022-08-22","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-06-02","2022-06-02","2022-04-12","2022-04-11","2022-04-11","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-02-04","2022-01-25","2022-01-07","2022-01-07","2021-11-09","2021-10-19","2021-10-12","2021-10-12","2021-10-09","2021-10-09","2021-10-09","2021-10-09","2021-10-07","2021-10-07","2021-10-07","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-09-28","2021-08-30","2021-08-19","2021-08-11","2021-08-02","2021-07-30","2021-07-30","2021-07-30","2021-05-26","2021-03-26","2021-03-26","2021-03-22","2021-02-09","2021-01-14","2020-12-16","2020-10-08","2020-10-08","2020-09-28","2020-08-07","2020-08-07","2020-07-28","2020-07-28","2020-07-22","2020-07-09","2020-06-01"],"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":[["","","TOBRAMYCIN\/DEXAMETHASONE","0","5","Select","Select",""],["","","ENALAPRIL MALEATE","5","90","Select","Select",""],["","","ESTRADIOL","1.000MG","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","112.000MCG","90","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4.000MG","90","Select","Select",""],["","","DILTIAZEM HYDROCHLORIDE ER","240.000MG","90","Select","Select",""],["","","PFIZER-BIONTECH COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","30.000MCG\/0.3ML","0","Select","Select",""],["","","PAROXETINE HYDROCHLORIDE","30.000MG","90","Select","Select",""],["","","TRIAZOLAM","0.000MG","2","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","12","Select","Select",""],["","","IBUPROFEN","600.000MG","15","Select","Select",""],["","","CELECOXIB","200.000MG","90","Select","Select",""],["","","FLUZONE HIGH-DOSE PF 2022-2023","0","1","Select","Select",""],["","","DILT-XR","240.000MG","90","Select","Select",""],["","","GAVILYTE-C","0","4000","Select","Select",""],["","","PROCTO-MED HC","2.00%","28","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":""}]}]}