{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORENZO BROADNAX","gend":0,"add":"PO BOX 695","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1962-11-11","age":"","mstatus":"","insh":"20045338*01","cliId":"","pno":7578009085,"cno":7578009085,"email":"","ename":"","eno":"","pphy":"MANN, JONATHAN R MD","ppno":7572529010,"pcpadd":"STE 710 301 RIVERVIEW AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23510-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Hospital Medicine Physicians - SNGH","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572529021,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L30.1","Z71.9","U07.1","G47.33","R06.02","K21.9","E66.9","R94.5","Z86.16","J84.10","R06.09","U09.9","L03.113","L30.9","R06.00","J30.89","G43.C0","M79.89","J32.9","K40.91","R10.9","NO DATA","J96.01","J81.0","E78.5","R05.3","F43.10","M19.90","Z80.1","Z82.3","Z82.49","Z80.42","N40.0","Z68.33","Z88.5","R05.9","R11.2","N52.9","S02.40FS","Z87.19","Z96.652","Z99.81","Z79.1","Z79.82","Z79.52","Z79.2","Z20.822","J06.9","R14.2","M20.21","R07.9","M25.471","R73.03","F33.1","G44.229","Z23.","R60.1","G47.34","M79.671","D64.9","R19.7","R52.","R53.83","R68.83","G44.209","K59.00","E78.00","Z88.6","R94.2","R42.","E16.2","J32.0","M25.561","R39.9","D50.8","G89.29","I87.2","R10.32","G44.40","I67.9","H81.12","M54.2","R09.82","G43.009","F51.05","F99.","Z12.5","M19.022","M19.021","M19.012","M19.011","M25.521","M25.522","J01.00","I49.1","I49.3","J32.1","E11.9","E11.69","G44.85","J30.2","R09.81","J34.2","J34.3","J01.11","K11.7","R13.10","K31.89","R00.2","R07.89","G43.909"],"date":["2021-11-18","2022-11-21","2023-02-03","2023-08-22","2021-12-17","2023-08-22","2023-06-30","2022-02-11","2023-02-22","2023-08-22","2023-02-22","2023-02-22","2022-04-23","2022-11-21","2022-02-04","2023-03-24","2022-02-07","2023-09-01","2023-03-13","2021-01-21","2021-04-14","2022-01-25","2022-01-25","2021-12-11","2023-08-22","2021-12-11","2023-08-22","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2023-08-22","2021-12-11","2021-12-11","2021-12-13","2021-12-11","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2023-02-02","2021-12-03","2023-04-24","2021-03-04","2021-06-10","2021-06-10","2022-03-21","2023-08-22","2021-06-10","2021-12-09","2021-12-13","2022-01-11","2021-05-27","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2022-02-03","2023-03-17","2023-03-14","2023-07-10","2022-03-21","2022-03-21","2022-03-21","2022-03-21","2022-03-31","2021-01-26","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2022-01-13","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2023-02-03","2023-03-29","2023-03-29","2023-03-24","2023-08-22","2023-04-19","2023-06-05","2023-07-10","2023-07-10","2023-04-28","2023-04-28","2023-04-28","2023-07-26","2023-07-26","2023-07-26","2023-09-22","2023-09-01","2023-08-22"],"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":[["","00536329736","CHILD ASA","CHW 81MG","90","Select","Select",""],["","00904679480","ASPIRIN","81 MG","30","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","42858010301","OXYCOD\/APAP","TAB 7.5-325","28","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","100","Select","Select",""],["","00093342201","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00009005604","MEDROL","TAB 4MG","21","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","45802012935","HALOBETASOL","CRE 0.0005","45","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","5","Select","Select",""],["","16714039501","CEFPODOXIME","TAB 200MG","7","Select","Select",""],["","65162044211","MECLIZINE","TAB 25MG","90","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","60","Select","Select",""],["","50111078751","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00904006116","ROBAFEN","SYP 100\/5ML","420","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","90","Select","Select",""],["","41100056656","MIRALAX","POW 3350","30","Select","Select",""],["","55111064530","OMEPRAZOLE","40 MG","30","Select","Select",""],["","13668015530","ESOMEPRA MAG","CAP 40MG DR","30","Select","Select",""],["","60505620202","CYCLOSPORINE","EMU 0.0005","60","Select","Select",""],["","42571016242","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","42","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","11","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","00143928501","AMOXICILLIN","875 MG","20","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","63044048409","AMMONIUM LAC","LOT 0.12","225","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","53885027025","ONETOUCH VERIO TEST STRIP","","25","Select","Select",""],["","65862078430","ESOMEPRAZOLE MAGNESIUM","40 MG","30","Select","Select",""],["","53885099425","ONETOUCH ULTRA TEST STRIP","","25","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","00002143611","EMGALITY PEN","120 MG\/ML","1","Select","Select",""],["","45802065078","LORATADINE","10 MG","30","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","28","Select","Select",""],["","53885014301","ONETOUCH DELICA","33 GAUGE","100","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","00904679480","ASPIRIN LOW CHW","81MG","30","Select","Select",""],["","00002143611","EMGALITY INJ","120MG\/ML","1","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","00093505998","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","55111064530","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","13668015530","ESOMEPRA MAG CAP","40MG DR","30","Select","Select",""],["","42571016242","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","00023916360","RESTASIS EMU","0.05%","60","Select","Select",""],["","60505620202","CYCLOSPORINE EMU","0.05%","60","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","90","Select","Select",""],["","42858000101","OXYCODONE TAB","5MG","42","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","28","Select","Select",""],["","00904404073","ASPIRIN CHW","81MG","30","Select","Select",""],["","50458058030","XARELTO TAB","10MG","11","Select","Select",""],["","65162044211","MECLIZINE TAB","25MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","21","Select","Select",""],["","63044048409","AMMONIUM LAC LOT","12%","225","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","68645056354","IBUPROFEN TAB","800MG","12","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","00143122701","DICYCLOMINE HCL","20 MG","90","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":""}]}]}