{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAMILA SANTIAGO","gend":1,"add":"2216 CAROLINE ST","city":"FREDERICKSBURG","state":"VA","zip":224019999,"dob":"1941-07-26","age":"","mstatus":"","insh":11012527,"cliId":"7NU9N96FK42","pno":5404294608,"cno":5406233946,"email":"","ename":"","eno":"","pphy":"CHANG, NORMAN A","ppno":5403714141,"pcpadd":"611 Jefferson Davis Hwy Ste 201","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224018402,"pcpcounty":"STAFFORD","pcpid":"P9307324","pcpname":"COMMONWEALTH INTERNAL MEDICINE PC"},{"a":[]},{"a":[]}]},{"t":"Curent Condition \/ Suspect Codes","q":[{"a":{"diag":["E11.65","R69","Z45.018","I44.2","M54.5","R10.9","M19.90","E11.9","E78.5","F02.80","G30.9","M33.90","M81.6","G30.8","R51","S09.90XA","M54.2","S19.9XXA","S00.91XA","R40.2362","R40.2142","R40.2252","W18.30XA","Y92.009","I10","Z95.0","E55.9","Z79.4","Z00.00","Z13.31","Z71.89","M06.9","W19.XXXA","Y92.89","Y93.89","M81.0","Z12.31","I25.119","R55"],"date":["2020-09-03","2020-06-01","2020-10-15","2020-10-15","2020-08-06","2020-04-23","2020-04-23","2020-08-31","2020-10-15","2020-06-16","2020-04-23","2020-08-06","2020-08-19","2020-06-16","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-08-12","2020-07-21","2020-08-06","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-31","2020-07-21","2020-07-21","2020-07-21","2020-09-17","2020-10-06","2020-10-15","2020-10-15"]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Screenings","q":[[["No","Select","",false,""],["No","Select","",false,""],["No","Select","",false,""],["No","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":{"indx":[{"index":7,"values":[{"index":"No Ethnicity"}]}],"comment":[],"score":0}}]},{"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":""}]}]}