{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A ASSYLANOTLAD ","gend":1,"add":"EKIPS 12911ENAL ENROH","city":"CHESTERFIELD","state":"VA","zip":238382946,"dob":"2004-09-03","age":"","mstatus":"","insh":"2664612","cliId":"","pno":"9740804310","cno":"","email":"","ename":"","eno":"","pphy":"POWERS, ELIZABETH A","ppno":"","pcpadd":"13540 Hull Street Rd","pcpcity":"Midlothian","pcpstate":"VA","pcpzip":231122107,"pcpcounty":"","pcpid":"P0060023","pcpname":"ST FRANCIS FAMILY MEDICINE CENTER","pcpfaxno":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F43.10","J02.9","J06.9","H66.93","J32.9","E66.9","Z68.54","Z86.19","J01.90","R10.32","J02.0","T43.632A","T46.5X2A","F33.2","F41.9","R00.1","I49.9","T43.222A","F90.9","T50.901A","R45.851","F43.20","F33.1","F10.10","F19.10","Z68.52","Z86.59","F32.9","Z03.6","E66.09","F33.40","Z51.81","E66.3","G47.9"],"date":["2019-06-24","2018-11-27","2018-10-09","2018-11-27","2018-11-27","2019-03-08","2018-11-27","2018-11-27","2018-11-27","2018-12-19","2018-12-26","2019-03-07","2019-03-07","2019-03-12","2019-03-12","2019-03-07","2019-03-07","2019-03-07","2019-04-22","2019-03-07","2019-03-08","2019-03-08","2019-03-08","2019-03-08","2019-03-08","2019-03-08","2019-03-08","2019-04-22","2019-03-09","2019-03-09","2019-03-14","2019-04-22","2019-04-22","2019-04-22"]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Screenings Needed","q":[[["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""]]]},{"t":"Self-Assessment and 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 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":"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":""}]}]}