{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALVIN J BALLARD III","gend":0,"add":"873 JEFFERSON DR","city":"PALMYRA","state":"VA","zip":229639999,"dob":"1969-07-23","age":"","mstatus":"","insh":11008455,"cliId":"6D12VQ2WE83","pno":4349620976,"cno":"","email":"","ename":"","eno":"","pphy":"MIX, WILLIAM A","ppno":4346541800,"pcpadd":"33 Rebecca Dr","pcpcity":"Palmyra","pcpstate":"VA","pcpzip":229636242,"pcpcounty":"FLUVANNA","pcpid":"P9120211","pcpname":"SENTRA PALMYRA MEDICAL ASSOCIATES"},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]}]},{"t":"Curent Condition \/ Suspect Codes","q":[{"a":{"diag":["F31.9","E11.9","E11.29","I10","E78.5","E11.65","Z79.4","R80.9","Z00.00","Z23","F31.64","N40.1","N20.0","N28.1","R35.1","R35.0","N39.41","Z87.448","E11.649","E10.649","E16.2","R73.09","E11.69"],"date":["2020-10-30","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2019-10-30","2020-09-29","2020-09-29","2019-11-08","2019-11-08","2019-11-08","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2020-08-27","2020-08-31","2020-07-22","2020-07-22","2020-07-29"]}},{"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":""}]}]}