{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN W FAIRLEY","gend":0,"add":"2629 Arlington Dr Apt 103","city":"Alexandria","state":"VA","zip":223063603,"dob":"1967-03-13","age":"","mstatus":"","insh":11013559,"cliId":"8KY3MA6XH13","pno":5712453632,"cno":"","email":"","ename":"","eno":"","pphy":"SANABRIA, FEDERICO","ppno":7039784200,"pcpadd":"9409B Old Burke Lake Rd","pcpcity":"Burke","pcpstate":"VA","pcpzip":220153127,"pcpcounty":"Fairfax","pcpid":"P0147213","pcpname":"BURKE FAMILY PRACTICE"},{"a":{"indx":[{"index":7,"values":[{"index":"No Ethnicity"}]}],"comment":[],"score":0}},{"a":[]}]},{"t":"Curent Condition \/ Suspect Codes","q":[{"a":{"diag":["F12.20","F14.20","F10.20","F25.9","Z65.3","F33.1","F43.12","M25.559","Z55.0","K80.20","K76.0","R07.9","I15.9","R06.02","I11.0","I50.22","E66.01","Z68.41","I25.10","N40.0","E78.5","M19.90","R94.5","R11.0","I25.2","F17.210","F10.10","Z79.82","Z74.3","L03.115","R23.4","E87.6","I10","Z82.49","L02.31","R07.89","K40.90"],"date":["2020-06-09","2020-06-09","2020-09-02","2020-06-09","2020-06-09","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-09-09","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-09-09","2020-09-09","2020-06-18","2020-09-09","2020-06-18","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-06-18","2020-09-09"]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Screenings","q":[[["Select","Select","",false,""],["Select","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":[]}]},{"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":""}]}]}