{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YRAMESORRELRAM ","gend":1,"add":"TS17 EN 525201 TPA TS ","city":"NEWPORT","state":"OR","zip":"97365","dob":"1950-05-25","age":"","mstatus":"","insh":"57000110912","cliId":"","pno":"6914517751","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":"525 NE 71ST ST APT 102","madd2":"","madd3":"","mcity":"NEWPORT","mstate":"","mzip":"97365","pcpfaxno":"","pcpnpi":"1740224351"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R279","R531","Z9181","J449"],"date":["2023-05-31","2023-05-31","2023-05-31","2023-06-03"],"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":[["","69097082312","Citalopram Hydrobromide","","90","Select","Select",""],["","65862020299","Losartan Potassium","","30","Select","Select",""],["","43598071901","Chlorthalidone","","30","Select","Select",""],["","60505082901","Fluticasone Propionate","","16","Select","Select",""],["","65862039110","Ondansetron","","30","Select","Select",""],["","13668008190","Montelukast Sodium","","30","Select","Select",""],["","832532410","Potassium Chloride Crys ER","","60","Select","Select",""],["","68682036890","dilTIAZem HCl ER Beads","","30","Select","Select",""],["","80681016900","Vitamin D3","","30","Select","Select",""],["","71036924","Dilantin","","150","Select","Select",""],["","172572880","Famotidine","","60","Select","Select",""],["","173089310","Trelegy Ellipta","","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":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"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":{"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":""}]}]}