{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH VILLARREAL","gend":1,"currentgend":"","add":"3386 W GILL PL","city":"DENVER","state":"CO","zip":"80219","dob":"1958-12-05","age":"","mstatus":"","insh":2000008135,"cliId":"","pno":"3039606703","cno":"3039606703","email":"","ename":"","eno":"","pphy":"BREITNAUER, NICHOLAS J","ppno":9704840722,"pcpadd":"NCAP LLP,1236 E ELIZABETH SUITE 2","pcpcity":"FORT COLLINS","pcpstate":"CO","pcpzip":"80524","pcpcounty":"","pcpid":"","pcpname":"PE\u00d1A PRIMARY CARE MEDICAL HOME","plan":"Denver Health","program":"Medicare","lob":"MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3386 W GILL PL","madd2":"","madd3":"","mcity":"DENVER","mstate":"CO","mzip":"80219","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2000008135","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","1","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R112","D123","M25511","K649","Z124","R918","H5203","R000","I4891","I4819","E119","I517","R490","R002","K449","F10129","L853","M5431","F10230","F1020","I491","J4489","Z029","J9811","R9389","K2289","Z1231","K2950","H524","H52223","G4733","R109","R140","I483","R059","R0602","Q2119","Z95818","J9601","F10239","R7401","J449","E66813","Z6836","I10","Z713","Z7182","Y908","I700","J441","M25512","Z9989","G8929","R791","R079","R519","F1010","F419","Z743","J0100","J4531","J4550","Z1159","R0600","Z9981","Z13820","Z780","R0989","Z48812","I5030","I2089","R9089","R92313","I480","Z006","E669","Z6837","E889","J410","K921","R1013","K5730","K3189","Z7901","I3139","R051","M19011","E65","E6601","K219","J069","B9789","H25093","H04123","H5202","R942","Z87891","J209","R091","R030","G4734","R9431","J9611","J90","R509","S33140A","M4186","M2578","M47896","I5032","F1090","R0902"],"date":["2022-12-10","2022-11-13","2023-01-31","2023-06-03","2023-03-31","2026-01-04","2024-11-05","2024-05-09","2025-02-12","2026-01-28","2026-01-06","2026-01-22","2025-01-14","2025-07-26","2026-01-06","2025-09-03","2025-09-20","2025-10-10","2022-03-20","2025-01-23","2025-09-13","2025-12-15","2026-01-22","2023-12-18","2025-09-13","2022-05-20","2025-11-14","2022-11-13","2025-09-18","2025-09-18","2026-01-06","2026-01-04","2023-12-18","2026-01-28","2024-10-15","2026-01-04","2026-01-22","2026-01-28","2025-09-07","2025-09-07","2025-09-07","2026-01-07","2025-09-12","2025-09-12","2026-01-28","2025-09-12","2025-09-12","2025-09-03","2026-01-22","2024-10-15","2022-04-19","2025-09-03","2022-04-19","2022-04-13","2026-01-06","2024-11-19","2025-09-03","2025-09-03","2025-09-04","2024-05-28","2025-09-13","2026-01-12","2022-02-11","2025-10-20","2026-01-20","2022-03-08","2022-03-08","2022-04-12","2024-08-01","2024-08-29","2024-08-29","2024-11-19","2025-11-14","2025-01-22","2025-01-22","2025-01-22","2025-01-22","2026-01-05","2026-01-15","2022-11-10","2026-01-04","2022-11-10","2022-11-10","2024-12-10","2025-01-22","2024-12-26","2023-02-01","2025-01-23","2025-04-29","2025-04-29","2025-09-13","2025-09-13","2025-09-18","2025-09-18","2025-09-18","2025-10-20","2025-10-20","2022-04-11","2022-04-11","2022-04-11","2023-07-23","2024-07-31","2025-12-15","2025-09-13","2025-09-04","2025-10-13","2025-10-13","2025-10-13","2025-10-13","2025-09-04","2025-02-12","2025-09-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","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":[]}]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","MOUNJARO","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","COMBIVENT RESPIMAT","","","Select","Select",""],["","","SURE COMFORT PEN NEEDLE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SINGLE USE SWAB","","","Select","Select",""],["","","PROCTOZONE-HC","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","VICTOZA 2-PAK","","","Select","Select",""],["","","TIOTROPIUM BROMIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","TRUEPLUS PEN NEEDLE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","CLORAZEPATE DIPOTASSIUM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of 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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":""}]}]}