{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L ANNODHCNYL ","gend":1,"add":"YWH WN 107204 TPA 101 ","city":"LINCOLN CITY","state":"OR","zip":"97367","dob":"1957-06-13","age":"","mstatus":"","insh":"38000110487","cliId":"","pno":"5706331573","cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"5419967480","pcpadd":"825 NW HWY 101 STE A,","pcpcity":"Lincoln City","pcpstate":"OR","pcpzip":"97367","pcpcounty":"","pcpid":"","pcpname":"","plan":"Samaritan Health Plans","program":"Medicare","lob":"PREM","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2701 NW HWY 101 APT 40","madd2":"","madd3":"","mcity":"LINCOLN CITY","mstate":"","mzip":"97367","pcpfaxno":"","pcpnpi":"1003983776"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T383X2A","E11649","E1165","E1140","R001","J9610","F319","F609","F4320","R8281","E669","Z6842","Z794","D649","G8929","M79604","M79605","M5450","S7292XD","Z20822","I10","Z9981","Z9181","Z87891","S72352D","J9611","I4820","I2720","E6601","F419","R110","R0789","Z7982","R531","Z888","Z880","Z01818","R9431","S72002D","E1340","N289","E559","M419","J309","F1290","Z602","Z7409","Z7985","Z791","S72402D","D62","E785","Z882","T84115A","Z6841","S72402K","E1142","G629","F4325","E119","F3181","I4891","Z7951","Z993","S72492A","S60221A","S72402G","S6991XA","M1711","R112","S72492K","M1712"],"date":["2023-02-08","2023-02-08","2023-06-08","2023-04-27","2023-02-08","2023-02-08","2023-06-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-04-27","2023-06-08","2023-06-12","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-06-08","2023-06-08","2023-05-16","2023-05-16","2023-02-01","2023-06-11","2023-06-08","2023-06-08","2023-06-08","2023-04-27","2023-02-01","2023-02-01","2023-06-08","2023-06-06","2023-02-01","2023-06-08","2023-05-26","2023-05-26","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-06-08","2023-05-16","2023-05-26","2023-06-08","2023-06-08","2023-02-11","2023-06-12","2023-06-08","2023-06-08","2023-06-08","2023-06-08","2023-02-08","2023-06-12","2023-02-08","2023-02-08","2023-04-27","2023-04-27","2023-03-27","2023-05-14","2023-06-12","2023-05-14","2023-02-22","2023-06-11","2023-05-26","2023-05-26"],"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":[["","169418113","Ozempic (0.25 or 0.5 MG\/DOSE)","","-9","Select","Select",""],["","93005805","traMADol HCl","","50","Select","Select",""],["","53885027150","OneTouch Verio","","50","Select","Select",""],["","8627005303","Dexcom G6 Sensor","","3","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":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"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":""}]}]}