{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LYREHCYENAH ","gend":1,"add":"OB OP47 X","city":"WALDPORT","state":"OR","zip":"97394","dob":"1956-04-17","age":"","mstatus":"","insh":"47000110345","cliId":"","pno":"0314583240","cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"5415633197","pcpadd":"920 SW RANGE DR,","pcpcity":"WALDPORT","pcpstate":"OR","pcpzip":"97394","pcpcounty":"","pcpid":"","pcpname":"","plan":"Samaritan Health Plans","program":"Medicare","lob":"SNP","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 74","madd2":"","madd3":"","mcity":"WALDPORT","mstate":"","mzip":"97394","pcpfaxno":"","pcpnpi":"1699790022"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","I495","I441","Z950","J439","N951","M810","G479","J209","R051"],"date":["2023-03-02","2023-06-19","2023-06-19","2023-06-19","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2023-06-24","2023-06-24"],"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":[["","49884094499","Varenicline Tartrate","","53","Select","Select",""],["","13668026801","carBAMazepine","","180","Select","Select",""],["","93317431","Albuterol Sulfate HFA","","8.5","Select","Select",""],["","27241009809","DULoxetine HCl","","90","Select","Select",""],["","68382080510","traZODone HCl","","20","Select","Select",""],["","64380018001","Doxycycline Monohydrate","","20","Select","Select",""],["","70074058296","Ensure","","237","Select","Select",""],["","55111015810","Omeprazole","","90","Select","Select",""],["","70954000520","Oxybutynin Chloride","","135","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":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""]],"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":""}]}]}