{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NERRAWRESUB ","gend":0,"add":"DARB 49NL WAHS","city":"LEAVENWORTH","state":"WA","zip":98826,"dob":"1955-09-03","age":"","mstatus":"","insh":"91114910842","cliId":"","pno":"2352490481","cno":"4253218409","email":"","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E13.9","I10","N18.9","E29.1","Z79.4","Z79.899","M25511","M948X1","M25811","M25411","S46011A","M7551","E1322","N189","Z23","E139","Z794","Z5181","H47323","H5203","H52223","H524","N1830","S43429D","E119","S42009D","S42009A","S43429A","E291","K8590","S42031A","S0081XA","W000XXA","Y9389","E1122","E785","I252","K219","K861","K8681","Z79899","Z79891","M25.511","M94.8X1","M25.811","M25.411","S46.011A","M75.51","E13.22","Z51.81","H47.323","H52.03","H52.223","H52.4","N18.30","S43.429D","E11.9","S42.009D","S42.009A","S43.429A","K85.90","S42.031A","S00.81XA","W00.0XXA","Y93.89","E11.22","E78.5","I25.2","K21.9","K86.1","K86.81","Z79.891"],"date":["2023-04-07","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2022-12-08","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-03","2022-10-03","2022-10-03","2022-09-16","2022-09-16","2022-09-16","2022-08-22","2022-08-18","2022-08-18","2022-08-18","2022-06-10","2022-06-10","2022-06-02","2022-05-11","2022-02-22","2022-02-22","2022-02-22","2022-02-22","2022-02-14","2022-02-14","2022-02-14","2022-02-14","2022-02-07","2022-01-30","2022-01-30","2022-01-30","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-12-08","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-03","2022-09-16","2022-08-22","2022-08-18","2022-08-18","2022-08-18","2022-06-10","2022-06-10","2022-06-02","2022-05-11","2022-02-22","2022-02-22","2022-02-22","2022-02-14","2022-02-14","2022-02-14","2022-02-14","2022-02-07","2022-01-30","2022-01-30","2022-01-30","2022-01-17","2022-01-17","2022-01-17"],"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":[["","","ROSUVASTATIN CALCIUM","40","90","Select","Select",""],["","","BENAZEPRIL HCL","40","90","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY\/SENSOR\/FLASH MONITORING SYSTEM","0","6","Select","Select",""],["","","BD PEN NEEDLE\/NANO\/ULTRA -FINE\/32G X 4MM","0","300","Select","Select",""],["","","CREON","0","540","Select","Select",""],["","","OMEPRAZOLE","20.000MG","90","Select","Select",""],["","","HUMALOG KWIKPEN","100.000UNIT\/ML","45","Select","Select",""],["","","FREESTYLE PRECISION NEO BLOOD GLUCOSE TEST STRIPS","0","100","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","-100","Select","Select",""],["","","TESTOSTERONE","50.000MG\/5GM","450","Select","Select",""],["","","LANTUS SOLOSTAR","100.000UNIT\/ML","30","Select","Select",""],["","","BENAZEPRIL HYDROCHLORIDE","20.000MG","180","Select","Select",""],["","","DICLOFENAC SODIUM DR","75.000MG","60","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":""}]}]}