{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TREBORYTTEP ","gend":0,"add":"WDRB W 0422721 # EVA Y","city":"MOSES LAKE","state":"WA","zip":98837,"dob":"1940-04-24","age":"","mstatus":"","insh":"87804910506","cliId":"","pno":"3490563101","cno":"5094310136","email":"","ename":"","eno":"","pphy":"PHILIP BUCKLEY","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Grant","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1720014947"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","J84.112","H52.4","H52.03","H52.223","H25.13","H02.831","H02.834","R05.3","J96.11","J30.1","Z51.81","R91.8","E119","I10","J84112","J9611","J301","H40013","H2513","E785","R058","Z0001","Z7984","Z23","R69","H25813","G4733","E6601","Z6841","Z20822","J849","E782","Z9981","Z5181","H40033","H40053","K219","L570","Z85828","L578","L720","H3561","R918","J383","I5030","Z8546","Z125","J84111","J9691","I509","G4730","H524","H5203","R05","R600","I110","Z139","K449","T17900A","E669","Z20828","E871","R768","M359","R911","I5032","J209","Z0189","I350","R590","L304","L821","R0989","R0600","R5383","I517","C61","F411","H40.013","E78.5","R05.8","Z00.01","Z79.84","H25.813","G47.33","E66.01","Z68.41","Z20.822","J84.9","E78.2","Z99.81","H40.033","H40.053","K21.9","L57.0","Z85.828","L57.8","L72.0","H35.61","J38.3","I50.30","Z85.46","Z12.5","J84.111","J96.91","I50.9","G47.30","R60.0","I11.0","Z13.9","K44.9","T17.900A","E66.9","Z20.828","E87.1","R76.8","M35.9","R91.1","I50.32","J20.9","Z01.89","I35.0","R59.0","L30.4","L82.1","R09.89","R06.00","R53.83","I51.7","F41.1"],"date":["2023-06-16","2023-06-09","2023-06-07","2023-06-07","2023-06-07","2023-06-07","2023-06-07","2023-06-07","2023-06-06","2023-06-06","2023-06-06","2023-06-06","2023-04-25","2022-12-16","2022-12-30","2022-12-09","2022-11-15","2022-11-15","2022-09-29","2022-09-29","2022-08-16","2022-08-16","2022-07-21","2022-07-21","2022-08-30","2022-07-12","2022-06-23","2022-06-14","2022-05-11","2022-05-11","2022-05-09","2022-04-29","2022-04-15","2022-04-13","2022-04-04","2022-03-22","2022-03-09","2022-01-27","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2021-11-09","2021-11-02","2021-11-02","2021-11-02","2021-10-11","2021-10-11","2021-07-10","2021-06-24","2021-06-24","2021-06-24","2021-06-22","2021-06-22","2021-07-14","2021-06-17","2021-06-17","2021-06-11","2021-02-05","2021-02-05","2020-12-29","2020-12-11","2020-10-21","2020-10-12","2020-09-30","2020-09-30","2020-09-30","2020-09-29","2020-09-11","2020-09-08","2020-09-08","2020-08-14","2020-08-14","2020-06-29","2020-06-08","2020-05-18","2020-05-01","2019-04-15","2019-03-26","2022-10-06","2022-09-06","2022-09-06","2022-08-04","2022-08-04","2022-06-29","2022-06-17","2022-07-21","2022-07-21","2022-05-13","2022-07-21","2022-07-21","2022-04-21","2022-04-07","2022-03-28","2022-07-21","2022-01-24","2022-01-24","2022-01-24","2022-01-24","2021-11-30","2021-11-08","2022-07-21","2021-10-21","2021-10-15","2021-07-15","2021-07-16","2021-07-16","2021-07-08","2021-07-14","2022-07-21","2021-06-21","2021-02-16","2021-02-16","2020-12-31","2022-01-17","2020-10-26","2020-12-07","2020-10-08","2020-10-08","2020-10-08","2020-10-05","2021-11-11","2020-09-17","2020-09-17","2020-08-20","2020-08-20","2020-07-02","2020-06-29","2020-05-28","2020-05-07","2021-01-28"],"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":[["","","OFEV","150","60","Select","Select",""],["","","LEVOCETIRIZINE DIHYDROCHLORIDE","5","30","Select","Select",""],["","","SPIRONOLACTONE","25","30","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","0","9","Select","Select",""],["","","ONDANSETRON ODT","4","30","Select","Select",""],["","","PANTOPRAZOLE SODIUM","20","30","Select","Select",""],["","","AMLODIPINE BESYLATE","10","30","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","100","Select","Select",""],["","","ALBUTEROL SULFATE","0.00%","-90","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","750.000MG","180","Select","Select",""],["","","ATORVASTATIN CALCIUM","20.000MG","90","Select","Select",""],["","","FLUTICASONE PROPIONATE","50.000MCG\/ACT","16","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20.000MEQ","90","Select","Select",""],["","","LOSARTAN POTASSIUM","100.000MG","90","Select","Select",""],["","","FLUZONE HIGH-DOSE PF 2022-2023","0","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":""}]}]}