{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLADNARSIRRAH ","gend":0,"add":"EFFEJ 61EVA NOSR","city":"ROCK ISLAND","state":"WA","zip":98850,"dob":"1959-09-07","age":"","mstatus":"","insh":"91014910789","cliId":"","pno":"8890593104","cno":"5098840139","email":"","ename":"","eno":"","pphy":"MICHAEL ABBOTT","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Douglas","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1336179928"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M50.00","M51.37","M47.12","R42","H93.13","E11.69","E78.5","Z79.4","K51.00","F32.4","G894","M5000","M4802","E119","E1159","E1169","F324","Z23","J020","J029","I10","K5100","F1120","H9393","E785","H524","H52222","Z794","M5137","Z1159","I152","K5190","Z87891","G4709","F17200","H53009","K08109","Z972","E6601","M79605","E118","E782","S82102A","Z4889","S82102D","Z967","M25462","Z4789","Z79899","S82252D","W228XXD","M1712","M7989","E1165","S82109S","S82142A","S82402A","T79A22A","E669","Z6833","S82255A","S82455A","G89.4","M48.02","E11.9","E11.59","J02.0","J02.9","F11.20","H93.93","H52.4","H52.222","Z11.59","I15.2","K51.90","Z87.891","G47.09","F17.200","H53.009","K08.109","Z97.2","E66.01","M79.605","E11.8","E78.2","S82.102A","Z48.89","S82.102D","Z96.7","M25.462","Z47.89","Z79.899","S82.252D","W22.8XXD","M17.12","M79.89","E11.65","S82.109S","S82.142A","S82.402A","T79.A22A","E66.9","Z68.33","S82.255A","S82.455A"],"date":["2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2022-12-13","2022-12-13","2022-12-13","2022-12-13","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2022-08-15","2022-08-15","2022-07-05","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-02-09","2022-02-09","2022-02-09","2022-01-12","2022-01-03","2022-01-03","2021-07-23","2021-05-27","2021-05-05","2021-05-05","2021-04-28","2021-04-28","2021-04-28","2021-02-12","2020-11-12","2020-11-12","2020-11-11","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-08-04","2020-07-17","2020-07-17","2020-06-16","2020-06-16","2020-06-04","2020-06-04","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2022-12-13","2022-12-13","2022-12-13","2022-09-16","2022-08-15","2022-08-15","2022-03-29","2022-03-29","2022-02-09","2022-02-09","2022-01-03","2022-01-03","2021-07-23","2021-05-27","2021-05-05","2021-05-05","2021-04-28","2021-04-28","2021-04-28","2021-02-12","2020-11-12","2020-11-12","2020-11-11","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-08-04","2020-07-17","2020-07-17","2020-06-16","2020-06-16","2020-06-04","2020-06-04","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2020-05-24"],"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":[["","","OXYCODONE\/ACETAMINOPHEN","0","84","Select","Select",""],["","","METHADONE HCL","10","28","Select","Select",""],["","","ENDOCET","0","84","Select","Select",""],["","","METHADONE HYDROCHLORIDE","10.000MG","28","Select","Select",""],["","","DIAZEPAM","10.000MG","20","Select","Select",""],["","","LISINOPRIL","5.000MG","90","Select","Select",""],["","","PRAVASTATIN SODIUM","20.000MG","90","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50.000MG","180","Select","Select",""],["","","NALOXONE HYDROCHLORIDE","4.000MG\/0.1ML","2","Select","Select",""],["","","HUMULIN 70\/30","0","100","Select","Select",""],["","","AMOXICILLIN","500.000MG","20","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":""}]}]}