{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARRIE E HARE","gend":1,"add":"13001 THORPE PARK CT","city":"BRISTOW","state":"VA","zip":201369999,"dob":"1975-05-08","age":"","mstatus":"","insh":11016507,"cliId":"3EU2YU9VY23","pno":2565720081,"cno":"","email":"","ename":"","eno":"","pphy":"DEROSA, GARY A","ppno":7033695959,"pcpadd":"8640 Sudley Rd","pcpcity":"Manassas","pcpstate":"VA","pcpzip":201104404,"pcpcounty":"","pcpid":"P9443011","pcpname":"NOVANT HEALTH UVA HEALTH SYSTEM BULL RUN"},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I82.621","M79.89","R23.0","T14.8XXA","L08.9","R06.02","Z98.890","S30.860A","B96.5","E66.9","I82.A19","I82.B11","I82.611","R91.1","T82.868A","Y83.8","Z68.41","T81.41XA","D35.01","F32.9","Z79.01","Z90.49","T81.42XA","R00.2","R07.89","I82.A11","M25.421"],"date":["2020-10-14","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-14","2020-10-13","2020-10-12","2020-10-13","2020-10-14","2020-10-12","2020-10-12","2020-10-12","2020-10-13","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-14","2020-10-21","2020-10-21","2020-10-21","2020-10-21"]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Screenings Needed","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 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":""}]}]}