{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J AMRONYRRAP ","gend":1,"add":"XOB OP5422 ","city":"WALDPORT","state":"OR","zip":"97394","dob":"1943-09-01","age":"","mstatus":"","insh":"58000110360","cliId":"","pno":"4303563610","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 2245","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":["R42","N179","R82998","I10","Z87891","S8261XA","G4733","J449","G47411","S93431A","I2510","I252","Z8673","K2270","K219","Z85820","S8261XD","S93431S","G8921","D649","I129","N1832","F32A","F419","E785","Z7982","Z7409","Z741","Z602","W010XXD","Y92009","Z951","Z1389","J441","Z20822","S098XXA","S0101XA","S41111A","S61412A","R0602","S82831D","S93431D","J309","E669","Z791","G8911","R32","R1319","S0990XA","Z9181","R9082","M47892","J9801"],"date":["2023-06-15","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2023-03-07","2023-05-31","2023-05-31","2023-05-31","2023-05-09","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-26","2023-05-28","2023-05-28","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-28","2023-04-01","2023-04-01","2023-04-01","2023-04-01","2023-04-01","2023-04-01","2023-04-01","2023-04-01","2023-05-10","2023-05-23","2023-05-10","2023-05-10","2023-05-28"],"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":[["","66993001968","Albuterol Sulfate HFA","","18","Select","Select",""],["","70700015010","Omeprazole","","30","Select","Select",""],["","43547040211","Furosemide","","30","Select","Select",""],["","378456105","Potassium Chloride ER","","-30","Select","Select",""],["","64380017101","Imipramine HCl","","90","Select","Select",""],["","49483034010","Acetaminophen","","30","Select","Select",""],["","43292055540","Vitamin B Complex","","30","Select","Select",""],["","65862029630","Rosuvastatin Calcium","","30","Select","Select",""],["","904679489","Aspirin Low Dose","","30","Select","Select",""],["","80681008500","Melatonin","","120","Select","Select",""],["","54032756","Fluticasone-Salmeterol","","-180","Select","Select",""],["","536100901","Ferrous Sulfate","","30","Select","Select",""],["","20555002200","High Potency Multivitamin","","30","Select","Select",""],["","93729605","Carvedilol","","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":[]}},{"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":""}]}]}