{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YELRIHSRENRUT D","gend":1,"add":"RAGUS 58DR NUR ","city":"RIDGEWAY","state":"VA","zip":241489999,"dob":"1958-06-27","age":"","mstatus":"","insh":"10118010","cliId":"2Y85UU1NC50","pno":"8667254251","cno":2768061590,"email":"","ename":"","eno":"","pphy":"EGGLESTON-CLARK, VALENICA R","ppno":5404637628,"pcpadd":"1107 Brookdale St","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"HENRY","pcpid":"P0117819","pcpname":"CARILION MEDICAL ASSOCIATES MARTINSVILLE","pcpfaxno":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]}]},{"t":"Curent Condition \/ Suspect Codes","q":[{"a":{"diag":["M96.1","M54.16","G89.4","N13.30","E11.9","E78.5","I10","R80.9","Z12.39","N18.3","M51.26","Z79.899","R82.998","N13.5","E11.40","G89.29","K21.9","Z79.84","Z46.6","N36.8","F45.42","M54.5","E78.00","F32.9","N28.89","N28.1","Z12.31"],"date":["2020-08-03","2020-08-03","2020-08-03","2020-01-17","2020-08-06","2020-08-06","2020-08-06","2020-01-10","2020-08-06","2020-01-10","2020-01-10","2020-08-06","2020-01-10","2020-08-10","2020-01-15","2020-01-15","2020-06-24","2020-01-15","2020-01-17","2020-01-17","2020-03-05","2020-06-24","2020-06-24","2020-06-24","2020-08-10","2020-08-10","2020-09-08"]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Screenings","q":[[["Yes","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""]]]},{"t":"Self-assessment & Social History","q":[{"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":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems","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":[null,null,null,null,null,null,""]},{"a":[0,"","",0,{"txt":""},{"malnutrition":[]}]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"icd-10","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a9":"","a10":[],"a11":""}]}]}