{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELVONN A DAVIS","gend":0,"add":"200 HOUGH AVE APT A","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1990-06-04","age":"","mstatus":"","insh":"20048857*01","cliId":"","pno":7578198275,"cno":7578198275,"email":"","ename":"","eno":"","pphy":"KRATOVIL, KRISTINA R MD","ppno":7572529500,"pcpadd":"6333 CENTER DRIVE BLDNG 3,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Comprehensive Weight Loss Solutions - Norfolk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579629801,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.2","E11.8","G47.33","I50.32","Z68.45","Z79.4","R00.0","F41.0","E55.9","E66.01","Z71.3","J96.01","R51.9","E11.65","F33.1"],"date":["2023-06-14","2023-06-14","2023-04-05","2023-05-02","2023-06-14","2023-06-14","2023-01-23","2023-05-15","2023-02-08","2022-07-26","2023-06-14","2023-06-14","2023-06-14","2023-02-09","2022-09-18"],"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":[["","43547028950","BUPROPION TAB","150MG SR","180","Select","Select",""],["","68382009405","CARVEDILOL TAB","12.5MG","60","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","2","Select","Select",""],["","67877041301","METFORMIN TAB","500MG ER","30","Select","Select",""],["","65862017360","TOPIRAMATE TAB","100MG","120","Select","Select",""],["","00002318280","TRULICITY INJ","4.5\/0.5","2","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX5\/32","100","Select","Select",""],["","81131031250","MELATONIN TAB","3MG","60","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","51267089099","CONTRAVE","8 MG-90 MG","120","Select","Select",""],["","67877041301","METFORMIN HCL ER","500 MG","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","8","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","100","Select","Select",""],["","68382009405","CARVEDILOL","12.5 MG","60","Select","Select",""],["","00169451714","WEGOVY","1.7MG\/0.75","3","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","60","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","45","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","20","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","60","Select","Select",""],["","00169413013","OZEMPIC","INJ 4MG\/3ML","3","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","43547028950","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","65862017160","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","81131031250","MELATONIN","TAB 3MG","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":[]}},{"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":""}]}]}