{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID DUTZER","gend":0,"add":"1845 THOMAS LN","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1959-09-02","age":"","mstatus":"","insh":"2404046*01","cliId":"","pno":7576755380,"cno":7576755380,"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":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579629801,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","I50.33","NO DATA","G47.33","F10.20","F10.10","Z13.89","Z51.81","F11.21","I13.0","I50.43","E66.2","N17.9","J96.11","Z68.42","J44.9","N40.0","M79.89","R25.2","I95.9","D50.9","G89.29","D69.6","I50.9","R33.9","I50.40","I51.7","Z71.9","E66.9","R07.9","R77.8","G47.31","E66.01","E88.81","I10.","Z68.41","M16.12","M25.552","G47.00","R06.02","E87.6","R07.1","N43.3","I42.0","I87.2","Z79.01","J96.02","G47.30","M54.9","M25.50","Z65.9","Z11.52","D63.1","D12.6","K59.04","N18.9","R73.03","R60.0","H31.012","H35.411","H34.823","H35.373","H43.812","I30.9","E87.3","J44.1","E87.8","K31.89","K63.5","M25.561","M17.11","M16.0","H35.342","Z96.1","H52.4","N50.89","I13.10","I12.9","I45.10","I50.32","M1A.0710","Z01.810","Z01.812","I48.91","M19.90","M16.9","Z68.38","Z01.818","F11.10"],"date":["2023-07-12","2023-06-26","2023-05-01","2023-05-24","2023-02-22","2022-03-11","2022-03-11","2022-03-11","2022-06-08","2022-08-11","2022-08-11","2022-08-11","2022-08-14","2022-08-11","2022-11-10","2023-06-26","2023-05-24","2022-04-18","2022-04-22","2022-08-11","2023-03-28","2022-04-18","2022-04-18","2023-05-24","2022-04-19","2022-04-19","2023-04-27","2022-09-14","2022-09-14","2022-08-14","2022-08-14","2022-12-03","2023-05-24","2023-05-01","2023-05-24","2023-01-13","2023-06-27","2023-07-27","2022-02-11","2022-04-22","2023-05-24","2022-08-12","2022-10-10","2022-10-11","2023-04-27","2023-04-27","2022-03-09","2023-04-27","2022-03-09","2022-03-09","2022-03-09","2022-06-06","2022-09-13","2022-10-31","2022-10-31","2022-04-22","2023-05-01","2022-10-04","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2022-08-11","2022-08-11","2022-08-14","2022-08-11","2023-02-17","2023-02-17","2022-03-11","2022-03-11","2022-03-11","2022-08-15","2022-08-15","2022-08-15","2022-10-04","2022-04-20","2022-09-14","2023-05-23","2023-04-27","2023-04-27","2023-05-23","2023-05-23","2023-05-24","2023-06-26","2023-05-01","2023-05-01","2023-05-24","2023-05-24"],"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":[["","00093735556","FINASTERIDE","5 MG","90","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","29300035001","ALLOPURINOL","300 MG","90","Select","Select",""],["","69238149101","BUMETANIDE","2 MG","180","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","28","Select","Select",""],["","50458057930","XARELTO","20 MG","90","Select","Select",""],["","00245531915","KLOR-CON M20","TAB 20MEQ ER","360","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","42","Select","Select",""],["","65862014505","CARVEDILOL","TAB 25MG","180","Select","Select",""],["","00310460012","BEVESPI","AER 9-4.8MCG","11","Select","Select",""],["","31722052010","HYDRALAZINE","TAB 25MG","180","Select","Select",""],["","68382013610","LOSARTAN POT","TAB 50MG","180","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","68382056928","ACAMPRO CAL","TAB 333MG","45","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","69097012403","TOPIRAMATE","100 MG","180","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","42806009430","POT CHLORIDE","POW 20MEQ","30","Select","Select",""],["","52817032410","MIDODRINE","TAB 5MG","90","Select","Select",""],["","65162041503","BUPREN\/NALOX","SUB 8-2MG","42","Select","Select",""],["","69292056201","METOLAZONE","2.5 MG","30","Select","Select",""],["","66993013597","FLUTIC\/VILAN","INH 100-25","60","Select","Select",""],["","00173085910","BREO ELLIPTA","INH 100-25","60","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","00904759180","FEROSUL","325(65) MG","30","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","08489831510","PEN NEEDLES","MIS 32GX4MM","100","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","9","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","55111046605","METOPROL SUC","TAB 25MG ER","15","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","60","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","00172392660","DIAZEPAM","5 MG","2","Select","Select",""],["","62756097083","BUPRENORPHINE-NALOXONE","8 MG-2 MG","28","Select","Select",""],["","00904759161","FERROUS SULFATE","325(65) MG","90","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5 MCG","12","Select","Select",""],["","12496030001","SUBLOCADE","300 MG\/1.5","1.5","Select","Select",""],["","55111064505","OMEPRAZOLE","40 MG","90","Select","Select",""],["","65862059805","TAMSULOSIN HCL","0.4 MG","90","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","400","Select","Select",""],["","16714085202","METOPROLOL SUCCINATE","25 MG","45","Select","Select",""],["","69238106901","POTASSIUM CHLORIDE","20 MEQ","360","Select","Select",""],["","43598037230","COLCHICINE","0.6 MG","60","Select","Select",""],["","08489831510","DROPLET PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","21922000909","DICLOFENAC GEL","1%","400","Select","Select",""],["","50458057930","XARELTO TAB","20MG","30","Select","Select",""],["","16729022501","SPIRONOLACT TAB","25MG","90","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","00245531915","KLOR-CON M","20 TAB 20MEQ ER","360","Select","Select",""],["","55111073005","ALLOPURINOL TAB","300MG","90","Select","Select",""],["","00185013001","BUMETANIDE TAB","2MG","60","Select","Select",""],["","16729009015","FINASTERIDE TAB","5MG","90","Select","Select",""],["","65862014505","CARVEDILOL TAB","25MG","180","Select","Select",""],["","68382013610","LOSARTAN POT TAB","50MG","180","Select","Select",""],["","76385013601","METOLAZONE TAB","2.5MG","30","Select","Select",""],["","65162041503","BUPREN\/NALOX SUB","8-2MG","42","Select","Select",""],["","42806009430","POT CHLORIDE POW","20MEQ","30","Select","Select",""],["","68382013210","TAMSULOSIN CAP","0.4MG","90","Select","Select",""],["","00310460012","BEVESPI AER","9-4.8MCG","11","Select","Select",""],["","68382013905","TOPIRAMATE TAB","50MG","180","Select","Select",""],["","52817032510","MIDODRINE TAB","10MG","90","Select","Select",""],["","00597015561","STIOLTO AER","2.5-2.5","4","Select","Select",""],["","00173086910","ANORO ELLIPT AER","62.5-25","60","Select","Select",""],["","00597010061","SPIRIVA SPR","2.5MCG","4","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","00173085910","BREO ELLIPTA INH","100-25","60","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","9","Select","Select",""],["","66993013597","FLUTIC\/VILAN INH","100-25","60","Select","Select",""],["","00904759180","FEROSUL TAB","325MG","30","Select","Select",""],["","55111046605","METOPROL SUC TAB","25MG ER","15","Select","Select",""],["","08489831510","PEN NEEDLES MIS","32GX4MM","100","Select","Select",""],["","00172392770","DIAZEPAM TAB","10MG","1","Select","Select",""],["","70954006020","PREDNISONE TAB","20MG","84","Select","Select",""],["","43386009019","GAVILYTE-G SOL","","4000","Select","Select",""],["","00169280015","SAXENDA","3 MG\/0.5ML","15","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","30","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","00904673080","ACETAMINOPHEN","500 MG","90","Select","Select",""],["","16714015901","ONDANSETRON HCL","4 MG","10","Select","Select",""],["","57896030410","STOOL SOFTENER-LAXATIVE","8.6MG-50MG","30","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":""}]}]}