{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BLANCA BURNS","gend":1,"add":"413 NOTTOWAY AVENUE","city":"BLACKSTONE","state":"VA","zip":238241611,"dob":"1950-10-15","age":"","mstatus":"","insh":11007691,"cliId":"4U04FA4GQ61","pno":4343213986,"cno":8044842571,"email":"","ename":"","eno":"","pphy":"AGBEIBOR, VICTOR H","ppno":8049778915,"pcpadd":"13540 Hull Street Rd","pcpcity":"Midlothian","pcpstate":"VA","pcpzip":231122107,"pcpcounty":"NOTTOWAY","pcpid":"P0060028","pcpname":"BLACKSTONE FAMILY PRACTICE CENTER"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]}]},{"t":"Curent Condition \/ Suspect Codes","q":[{"a":{"diag":["F25.0","Z68.23","F20.9","I51.9","F25.1","R20.8","R53.81","M79.18","M25.511","M25.562","M54.9","E11.9","E78.00","I10","J45.909","F17.210","Z87.11","Z79.84","Z79.899","R10.30","R19.00","N39.0","R10.33","W10.8XXA"],"date":["2019-09-18","2019-07-24","2019-07-31","2019-07-31","2020-10-27","2019-08-21","2020-09-16","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2020-01-13","2020-01-12","2020-01-13","2020-01-13","2019-09-10"]}},{"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":""}]}]}