{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YTTAPREYOR","gend":1,"add":" I 616WS TS","city":"QUINCY","state":"WA","zip":98848,"dob":"1966-01-12","age":"","mstatus":"","insh":"91014910974","cliId":"","pno":"1390527702","cno":"5093120772","email":"","ename":"","eno":"","pphy":"DANIEL PUGMIRE","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":"1578853784"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","E2740","Z0101","H40053","H25812","H2511","H524","H52223","Z124","Z01411","Z1151","N930","N9410","Z90711","Z136","F411","G43109","Z13220","E039","R569","N3944","E230","E236","G40909","E83110","F331","R32","Z1231","E038","E2749","G4700","Z79899","N390","R1031","R531","I10","R112","R102","A084","D352","E249","R197","F419","F329","E27.40","Z01.01","H40.053","H25.812","H25.11","H52.4","H52.223","Z12.4","Z01.411","Z11.51","N93.0","N94.10","Z90.711","Z13.6","F41.1","G43.109","Z13.220","R56.9","N39.44","E23.0","E23.6","G40.909","E83.110","F33.1","Z12.31","E03.8","E27.49","G47.00","Z79.899","N39.0","R10.31","R53.1","R11.2","R10.2","A08.4","D35.2","E24.9","R19.7","F41.9","F32.9"],"date":["2023-06-08","2022-12-07","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-07-06","2022-03-22","2022-02-14","2022-02-14","2022-02-14","2021-12-14","2021-10-12","2021-10-04","2021-10-04","2021-07-23","2021-06-30","2021-06-30","2021-06-25","2021-06-25","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-11-03","2020-07-22","2020-07-22","2019-04-24","2019-04-24","2019-04-24","2022-12-07","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-03-22","2022-02-14","2022-02-14","2022-02-14","2021-12-14","2021-10-12","2021-10-04","2021-07-23","2021-06-30","2021-06-30","2021-06-25","2021-06-25","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-11-03","2020-07-22","2020-07-22","2019-04-24","2019-04-24","2019-04-24"],"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":[["","","HYDROCORTISONE","5","360","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4","90","Select","Select",""],["","","GABAPENTIN","300","150","Select","Select",""],["","","LATANOPROST","0.00%","2","Select","Select",""],["","","CLONAZEPAM","2.000MG","90","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","100.000MG","90","Select","Select",""],["","","LEVOTHYROXINE SODIUM","150.000MCG","90","Select","Select",""],["","","ROSUVASTATIN CALCIUM","10.000MG","90","Select","Select",""],["","","ESTRADIOL","0.000MG\/GM","42","Select","Select",""],["","","FLUBLOK QUADRIVALENT 2022-2023","0","1","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","100.000MG","10","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":""}]}]}