{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C EIRRACRETNEPRA","gend":1,"add":" ELPAM 548141 TINU TS","city":"WENATCHEE","state":"WA","zip":98801,"dob":"1948-03-21","age":"","mstatus":"","insh":"90604910403","cliId":"","pno":"4790509401","cno":"5097410490","email":"","ename":"","eno":"","pphy":"BRIAN DERRICK","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":"1578573614"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R69","L820","D2372","D225","Z0000","I10","M8589","Z87891","Z780","Z1321","E039","E782","M419","M47814","M5134","M5450","Z20828","L578","Z85820","Z85828","L821","Z20822","J029","R0981","Z1159","F40243","Z6837","Z1231","Z803","N3010","L700","L570","D230","G43909","K219","Z1211","D122","D124","D125","E785","E079","R002","D126","L82.0","D23.72","D22.5","Z00.00","M85.89","Z87.891","Z78.0","Z13.21","E03.9","E78.2","M41.9","M47.814","M51.34","M54.50","Z20.828","L57.8","Z85.820","Z85.828","L82.1","Z20.822","J02.9","R09.81","Z11.59","F40.243","Z68.37","Z12.31","Z80.3","N30.10","L70.0","L57.0","D23.0","G43.909","K21.9","Z12.11","D12.2","D12.4","D12.5","E78.5","E07.9","R00.2","D12.6"],"date":["2023-06-14","2022-12-09","2022-12-09","2022-12-09","2022-11-18","2022-11-18","2022-11-18","2022-11-18","2022-10-11","2022-10-07","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-07-29","2022-04-02","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2021-09-24","2021-09-24","2021-09-24","2021-07-22","2021-07-22","2021-07-22","2021-07-15","2021-07-15","2021-06-22","2021-01-19","2021-01-19","2021-01-19","2020-12-22","2020-12-22","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-08-21","2020-08-20","2022-12-09","2022-12-09","2022-12-09","2022-11-18","2022-11-18","2022-11-18","2022-10-11","2022-10-07","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-07-29","2022-04-02","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2021-09-24","2021-09-24","2021-09-24","2021-07-22","2021-07-22","2021-07-22","2021-07-15","2021-07-15","2021-06-22","2021-01-19","2021-01-19","2021-01-19","2020-12-22","2020-12-22","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-08-21","2020-08-20"],"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":[["","","LORAZEPAM","1","10","Select","Select",""],["","","AMITRIPTYLINE HYDROCHLORIDE","25","90","Select","Select",""],["","","SIMVASTATIN","20","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","75","90","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","2.000MG","40","Select","Select",""],["","","PFIZER-BIONTECH COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","30.000MCG\/0.3ML","0","Select","Select",""],["","","OMEPRAZOLE","40.000MG","90","Select","Select",""],["","","FLOWFLEX COVID-19 ANTIGEN HOME TEST","0","8","Select","Select",""],["","","RIZATRIPTAN BENZOATE","10.000MG","18","Select","Select",""],["","","SCOPOLAMINE","1.000MG\/3DAYS","2","Select","Select",""],["","","AMITRIPTYLINE HCL","25.000MG","90","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":""}]}]}