{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SINNEDTTENNEB","gend":0,"add":"NITS 0477DR LLIH E","city":"CASHMERE","state":"WA","zip":98815,"dob":"1947-08-27","age":"","mstatus":"","insh":"91014910325","cliId":"","pno":"6260440941","cno":"4062614904","email":"","ename":"","eno":"","pphy":"EMILY EGDAMIN","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":"1811376551"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G25.3","G25.81","R40.0","R41.89","R29.3","R44.1","R26.89","F34.89","E11.65","E22.1","E78.5","I10","H53.30","G2581","M0579","G8929","R451","F3289","E1165","D352","Z79899","G20","F0280","G253","R400","R4189","R519","I152","E7800","E269","R0789","R5382","E119","F329","G252","R259","N4883","R39198","I959","M8949","R768","I2510","E261","H9313","R000","E785","K219","M059","M47812","M8938","M4602","M9981","M50222","M4802","M4312","M5030","R251","M542","M545","M25559","M532X2","M160","M47816","G4710","R351","Z9181","Z7984","R2681","M7910","R1310","G4719","R6882","R531","E279","R0600","G43709","R05","T17908D","R1319","G43719","R42","G319","M05.79","G89.29","R45.1","F32.89","D35.2","Z79.899","F02.80","R51.9","I15.2","E78.00","E26.9","R07.89","R53.82","E11.9","F32.9","G25.2","R25.9","N48.83","R39.198","I95.9","M89.49","R76.8","I25.10","E26.1","H93.13","R00.0","K21.9","M05.9","M47.812","M89.38","M46.02","M99.81","M50.222","M48.02","M43.12","M50.30","R25.1","M54.2","M54.5","M25.559","M53.2X2","M16.0","M47.816","G47.10","R35.1","Z91.81","Z79.84","R26.81","M79.10","R13.10","G47.19","R68.82","R53.1","E27.9","R06.00","G43.709","T17.908D","R13.19","G43.719","G31.9"],"date":["2023-05-22","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2022-11-15","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-11-04","2022-11-04","2022-07-25","2022-07-25","2022-07-25","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-04","2022-05-04","2022-05-04","2022-04-28","2022-04-28","2022-02-09","2022-02-09","2022-02-03","2022-01-13","2022-01-12","2022-01-12","2022-01-12","2021-11-17","2021-11-17","2021-11-09","2021-11-03","2021-11-03","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-08-11","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2020-11-30","2020-11-30","2020-10-28","2020-10-28","2020-10-14","2020-10-14","2020-10-14","2020-09-14","2020-09-09","2020-09-09","2020-09-09","2020-08-11","2020-08-07","2020-08-06","2020-08-06","2020-08-06","2020-06-29","2020-06-21","2020-06-21","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-11-04","2022-07-25","2022-07-25","2022-05-11","2022-05-04","2022-05-04","2022-05-04","2022-04-28","2022-04-28","2022-02-09","2022-02-09","2022-02-03","2022-01-13","2022-01-12","2022-01-12","2022-01-12","2021-11-17","2021-11-17","2021-11-09","2021-11-03","2021-11-03","2021-10-06","2021-10-06","2021-10-06","2021-08-11","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2020-11-30","2020-11-30","2020-10-28","2020-10-28","2020-10-14","2020-10-14","2020-10-14","2020-09-14","2020-09-09","2020-09-09","2020-09-09","2020-08-11","2020-08-07","2020-08-06","2020-08-06","2020-06-29","2020-06-21"],"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":[["","","METOPROLOL SUCCINATE ER","100","90","Select","Select",""],["","","SPIRONOLACTONE","50.000MG","90","Select","Select",""],["","","CLOTRIMAZOLE","10.000MG","50","Select","Select",""],["","","OMEPRAZOLE","20.000MG","120","Select","Select",""],["","","PREDNISONE","20.000MG","10","Select","Select",""],["","","ROPINIROLE HYDROCHLORIDE","0.000MG","30","Select","Select",""],["","","NORTRIPTYLINE HCL","25.000MG","90","Select","Select",""],["","","ZOLPIDEM TARTRATE","5.000MG","30","Select","Select",""],["","","TRAMADOL HCL","50.000MG","30","Select","Select",""],["","","LEVETIRACETAM","1000.000MG","60","Select","Select",""],["","","LEVETIRACETAM ER","500.000MG","180","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":""}]}]}