{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D NIVEKLLINNU","gend":0,"add":"VIL 701LOOPRE","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1978-06-19","age":"","mstatus":"","insh":"4613210*59","cliId":"","pno":"32\/1755613-9","cno":"571\/239-3165","email":"","ename":"","eno":"","pphy":"JAVERNICK, MICHAEL J MD","ppno":"757\/345-4600","pcpadd":"STE 450 400 SENTARA CIRCLE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F45.42","G89.4","F41.1","R19.7","K86.1","R10.12","R63.4","R93.3","R10.13","R10.9","E86.0","Z87.19","Z86.79","R11.2","D72.829","F12.90","F11.90","G89.29","E83.118","Z14.8","Z79.899","Z23.","E83.119","E87.2","F34.1","F43.23","R10.84","R10.10","R52.","F41.9","R11.11","F11.20","R91.8","D53.9","K21.9","Z98.1","Z90.49","Z82.49","Z82.3","Z83.3","Z80.51","Z82.61","Z80.8","K85.00","R64.","E83.42","R94.31","I45.6","Z88.8","Z91.018","Z68.23","K58.8","M79.2","F54.","Z09.","K29.70","B37.49","K92.1","K31.84","R20.2","N40.0","R68.81","R14.0","E66.3","Z68.25","R63.0","E87.6","Z80.1","K58.0","K86.9","Z01.89","K86.89","R00.1","R91.1","Z76.89","NO DATA","K85.90","R11.0","R09.02","R69.","Z20.828","N30.00","K51.00","K52.9","F19.10","J84.10","S83.8X2A","M25.562","F32.9","S76.911A","Z20.822","R73.9","R79.89","R11.14","K58.9","M22.42","V58.89","Z88.5","M54.2","R10.11","R14.2","R10.33","F12.10","F17.200","E16.1","E16.2","R50.9","Z87.898","Z79.891","A08.4","D68.52","Z98.890"],"date":["2020-10-19","2022-05-18","2022-10-05","2020-11-03","2022-09-02","2022-01-25","2020-11-03","2020-11-03","2022-05-09","2022-09-29","2022-06-29","2022-06-29","2020-11-25","2022-08-30","2022-04-21","2022-04-23","2022-08-30","2022-09-29","2020-11-25","2021-03-26","2022-05-09","2021-03-26","2021-07-30","2022-01-27","2022-10-05","2022-10-05","2022-08-16","2022-06-06","2022-05-09","2022-09-29","2022-08-16","2021-12-17","2021-12-17","2022-04-23","2022-08-30","2022-04-23","2022-06-29","2022-04-23","2022-04-23","2022-04-23","2022-04-23","2022-04-23","2022-04-23","2022-01-25","2022-01-25","2022-08-12","2022-01-25","2022-04-21","2022-09-02","2022-04-21","2022-01-25","2022-05-18","2022-06-23","2022-10-05","2022-08-30","2020-09-15","2020-09-14","2020-09-14","2021-05-07","2020-09-14","2020-11-10","2020-10-26","2020-09-15","2020-09-14","2020-09-14","2020-11-22","2020-11-22","2022-04-23","2020-12-09","2020-12-09","2021-05-07","2021-07-01","2021-07-23","2021-12-09","2021-11-30","2021-12-16","2022-01-26","2022-08-16","2022-04-23","2022-06-13","2020-09-14","2020-09-14","2020-11-03","2020-11-10","2020-11-09","2020-11-10","2021-06-14","2021-06-15","2020-08-17","2021-06-15","2022-04-23","2021-06-29","2021-06-29","2021-12-17","2021-05-07","2021-07-07","2021-07-07","2021-08-06","2021-12-16","2022-08-30","2020-09-16","2021-02-23","2021-12-23","2021-12-23","2022-01-25","2022-01-25","2022-01-25","2020-12-08","2022-04-21","2020-10-30","2020-10-30","2022-04-21"],"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":[["","10702001801","OXYCODONE","TAB 5MG","15","Select","Select",""],["","70156010501","HYOSCYAMINE","SUB 0.125MG","90","Select","Select",""],["","00406912576","FENTANYL","DIS 25MCG\/HR","10","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00023611201","ZENPEP","CAP 20000UNT","270","Select","Select",""],["","00591024110","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","13668033101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","62756035664","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","31722094905","OXYCOD\/APAP","TAB 5-325MG","46","Select","Select",""],["","59011042010","OXYCONTIN","TAB 20MG CR","8","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","90","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","180","Select","Select",""],["","51991074810","DULOXETINE","CAP 60MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","00406831501","MORPHINE","TAB 15MG ER","8","Select","Select",""],["","46287050630","SIMETHICONE","DRO 40\/0.6ML","30","Select","Select",""],["","68462040601","INDOMETHACIN","CAP 25MG","12","Select","Select",""],["","58914011710","VIOKACE","TAB 20880","270","Select","Select",""],["","67405060403","FLUCONAZOLE","TAB 200MG","12","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","24","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":""}]}]}