{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ATREBORNELLA M","gend":1,"add":"34 498EVA DR","city":"SWEET HOME","state":"OR","zip":"97386","dob":"1965-04-20","age":"","mstatus":"","insh":"38000110918","cliId":"","pno":"5214599899","cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":",","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Samaritan Health Plans","program":"Medicare","lob":"PREM","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"894 43RD AVE","madd2":"","madd3":"","mcity":"SWEET HOME","mstate":"","mzip":"97386","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I639","G8191","R29810","R519","R001","R9431","I132","E1122","N186","I5032","I4891","I252","Z992","Z13220","E119","Z7901","Z87891","Z79899","I619","R531","I63233","G43909","I517","E1129","I10","K219","K3184","R471","K2100","E559"],"date":["2023-06-15","2023-06-10","2023-06-10","2023-06-10","2023-06-12","2023-06-12","2023-06-10","2023-06-14","2023-06-15","2023-06-10","2023-06-15","2023-06-10","2023-06-14","2023-05-22","2023-06-15","2023-06-10","2023-06-10","2023-06-10","2023-06-10","2023-06-09","2023-06-11","2023-06-15","2023-06-12","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2023-06-13","2023-06-11","2023-06-11"],"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":[["","31722052101","hydrALAZINE HCl","","90","Select","Select",""],["","904679480","Aspirin Low Dose","","30","Select","Select",""],["","60505267108","Atorvastatin Calcium","","30","Select","Select",""],["","23155062801","Isosorbide Mononitrate ER","","30","Select","Select",""],["","406012301","HYDROcodone-Acetaminophen","","40","Select","Select",""],["","172572870","Famotidine","","15","Select","Select",""],["","310110539","Lokelma","","6","Select","Select",""],["","59746011506","Prochlorperazine Maleate","","30","Select","Select",""],["","781208102","Calcium Acetate (Phos Binder)","","180","Select","Select",""],["","31722071310","Pantoprazole Sodium","","180","Select","Select",""],["","43547040310","Furosemide","","180","Select","Select",""],["","69097012715","amLODIPine Besylate","","30","Select","Select",""],["","93220401","Metoclopramide HCl","","60","Select","Select",""],["","3089321","Eliquis","","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":["","1"],"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":{"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":""}]}]}