{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDSAY   L SHEPHEARD","gend":1,"add":"3417 S CRESTLINE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1951-02-27","age":"","mstatus":"","insh":"900038248*01","cliId":"8K49CM2JY42","pno":"757\/407-6628","cno":"757\/407-6628","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MEDICARE PCP MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"800MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","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":["I48.0","R94.6","M20.41","M20.42","I87.2","D48.5","E78.5","G62.9","R73.09","Z13.1","Z13.228","G90.09","L03.116","M20.5X1","M20.5X2","M79.672","G57.52","Z12.31","Z13.820","M85.80","N95.9","Z87.828","Z23.","I47.1","I07.1","I34.0","Z20.828","Z01.419","Z12.39","Z12.12","I48.91","L82.0","D18.01","L81.8","D22.5","L57.0","D51.9","Z78.0","M85.89","S86.312D","Q66.222","H93.11","H90.A21","S86.312A","D22.39","D22.72","D22.61","D22.4","D22.71","D22.62","L81.4","L82.1","L57.8","Z71.89"],"date":["2021-11-16","2020-08-11","2020-08-11","2020-08-11","2020-08-21","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2020-10-09","2020-08-21","2020-11-11","2020-09-30","2020-11-11","2020-11-11","2021-10-20","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2020-09-26","2020-07-23","2020-07-23","2020-07-23","2021-01-16","2021-02-02","2021-02-02","2021-02-02","2020-07-16","2020-11-23","2020-11-23","2020-11-23","2021-11-08","2021-11-08","2020-10-09","2021-06-01","2021-06-01","2021-10-06","2021-10-06","2021-11-12","2021-11-12","2021-08-25","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08"],"priorHcc":[null,"","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","",null,null,"","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","050458057990","XARELTO ","20MG","90","Select","Select",""],["","062559043130","HYDROCORTISO ","2.50%","30","Select","Select",""],["","068180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","068180012201","CEPHALEXIN ","500MG","20","Select","Select",""],["","067877057305","BENZONATATE ","100MG","30","Select","Select",""],["","50458057990","","20MG","90","Select","Select",""],["","50458057990","XARELTO","20MG","90","Select","Select",""],["","68180012201","CEPHALEXIN","500MG","20","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","62559043130","HYDROCORTISO","2.50%","30","Select","Select",""],["","51672139409","TRETINOIN ","CRE 0.0005","45","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}