{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ANORYARG L","gend":1,"add":"EDISLLIH 2411E5B TPA EVA ","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1971-09-07","age":"","mstatus":"","insh":"35500210*46","cliId":"","pno":"74\/7570864-2","cno":"757\/472-4680","email":"","ename":"","eno":"","pphy":"KULKARNI, KEDAR P MD","ppno":"757\/252-9150","pcpadd":"301 RIVERVIEW AVE STE 810","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Fort Norfolk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F11.99","F10.99","F33.9","F41.9","G47.00","F10.20","F10.239","F14.20","F11.24","F32.9","Z09.","M46.46","M54.31","F10.920","A41.9","M54.41","I34.0","I36.1","L02.91","M86.00","K70.30","A53.0","F11.90","M86.9","J43.1","K02.9","M46.27","M46.47","T50.904A","K70.31","R60.1","F10.10","Z72.0","R53.83","M25.559","F11.23","N39.0","F17.210","Z62.810","K21.9","F14.10","F10.24","F14.14","I69.998","R26.89","Z59.0","K74.60","R18.8","R78.81","T40.1X1A","L02.215","L03.315","C53.9","I69.398","H53.8","R50.9","L03.818","M54.9","Z86.19","F19.90","M86.08","R03.0","N76.0","R06.02","N28.1","Z13.228","J43.9","Z87.898","A41.1","J69.0","A52.8","E83.51","F10.220","D53.9","B19.20","D50.9","E87.6","R91.1","F10.230","Z86.73","U07.1","N90.1","Z71.6","Z03.89","F33.1","G56.01","M18.12","T16.2XXA","Z20.822","Z98.890","NO DATA","J02.9","R11.2","R22.9","M54.32","R39.9","N30.00","R60.9","M15.9","R10.9","F11.288","F14.280","F14.24","F10.280","R60.0","M19.042","F15.10","A59.9","M25.552","M25.551","M25.572","M25.571","M79.672","M79.671","M25.472","M25.471","M79.89","Z76.0","M25.474","M25.475","R00.0","Z20.2","L29.3","N94.11","R30.9","R19.00","Z11.51","B96.89","Z72.51","A40.9","F19.99","M46.26"],"date":["2022-11-21","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-04-30","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2022-05-02","2022-07-13","2022-07-03","2022-07-04","2022-07-28","2022-07-03","2022-07-05","2022-07-05","2022-08-10","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-07-30","2022-07-29","2022-07-28","2022-07-28","2022-08-29","2022-07-02","2021-01-08","2022-05-19","2022-01-06","2022-01-06","2021-04-02","2021-04-26","2021-09-24","2022-08-29","2021-04-26","2021-09-24","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2022-07-13","2022-03-30","2022-07-12","2022-08-29","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2022-07-02","2022-07-07","2022-07-07","2022-08-12","2020-10-14","2022-02-09","2022-05-19","2022-07-02","2022-05-19","2022-07-02","2022-05-19","2022-07-02","2022-07-07","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2020-10-13","2022-08-29","2022-01-06","2022-03-10","2022-03-10","2022-07-08","2021-10-05","2021-08-19","2021-08-19","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-02-23","2022-10-25","2022-10-25","2020-08-12","2020-10-13","2020-10-13","2021-02-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2021-02-12","2022-01-06","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-07-05","2022-07-07","2022-07-07","2022-07-12"],"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":[["","25021067376","GLYDO","GEL 0.02","60","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","17478071130","LIDOCAINE","GEL 2% JELLY","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","1","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","45963043963","CONSTULOSE","SOL 10GM\/15","900","Select","Select",""],["","45963043864","ENULOSE","SOL 10GM\/15","1419","Select","Select",""],["","76282066339","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","43598065530","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","42","Select","Select",""],["","53489014310","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","14","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","18","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","14","Select","Select",""],["","65862001130","SERTRALINE","TAB 25MG","90","Select","Select",""],["","00185061501","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","68462043518","ACAMPRO","TAB 333MG","180","Select","Select",""],["","00378537501","DOXEPIN","CAP 75MG","30","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","1","Select","Select",""],["","00555015902","CHLORDIAZEP","CAP 25MG","15","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","14","Select","Select",""],["","53746027201","SMZ\/TMP","TAB 800-160","1","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","69543038130","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","42799012001","BUMETANIDE","TAB 1MG","14","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","60","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","120","Select","Select",""],["","63304007601","POT  CHLORIDE","TAB 10MEQ ER","7","Select","Select",""],["","75834010901","CHLORTHALID","TAB 25MG","1","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","11845005651","B-1","TAB 100MG","30","Select","Select",""],["","27241000306","RISPERIDONE","TAB 0.5MG","28","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":[]}},{"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":""}]}]}