{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAC SELRETNEP","gend":0,"add":" ELPAM 548141 TINU TS","city":"WENATCHEE","state":"WA","zip":98801,"dob":"1947-07-21","age":"","mstatus":"","insh":"90604910533","cliId":"","pno":"4790519401","cno":"5097410491","email":"","ename":"","eno":"","pphy":"ALEXANDRA GRAHAM","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":"1811300254"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H401111","H401122","H2513","I10","I2510","E785","Z8546","R69","R590","H6981","R7301","E781","I714","Z20822","J029","R0981","Z0000","H9201","H02403","H5213","D123","K5730","Z86010","H40.1111","H40.1122","H25.13","I25.10","E78.5","Z85.46","R59.0","H69.81","R73.01","E78.1","I71.4","Z20.822","J02.9","R09.81","Z00.00","H92.01","H02.403","H52.13","D12.3","K57.30","Z86.010"],"date":["2022-12-29","2022-12-29","2022-12-29","2022-10-07","2022-10-07","2022-10-07","2022-10-07","2022-06-16","2022-04-16","2022-04-05","2022-04-05","2022-04-05","2021-10-05","2021-09-24","2021-09-24","2021-09-24","2021-04-02","2021-04-02","2021-02-22","2021-02-22","2020-10-01","2020-10-01","2020-10-01","2022-12-29","2022-12-29","2022-12-29","2022-10-07","2022-10-07","2022-10-07","2022-04-16","2022-04-05","2022-04-05","2022-04-05","2021-10-05","2021-09-24","2021-09-24","2021-09-24","2021-04-02","2021-04-02","2021-02-22","2021-02-22","2020-10-01","2020-10-01","2020-10-01"],"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":[["","","AMLODIPINE BESYLATE","5.000MG","135","Select","Select",""],["","","METOPROLOL SUCCINATE ER","50.000MG","90","Select","Select",""],["","","TIMOLOL MALEATE","0.00%","15","Select","Select",""],["","","ROSUVASTATIN CALCIUM","40.000MG","90","Select","Select",""],["","","LOSARTAN POTASSIUM","100.000MG","90","Select","Select",""],["","","PFIZER-BIONTECH COVID-19 VACCINE\/BIVALENT\/BA.4\/BA.5","30.000MCG\/0.3ML","0","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","0.00%","473","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5.000MG","18","Select","Select",""],["","","AZITHROMYCIN","250.000MG","6","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":""}]}]}