{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA FURTADO","gend":1,"add":"9006 BUSH DR","city":"GLEN ALLEN","state":"VA","zip":230609999,"age":"","mstatus":"","insh":22027056801,"cliId":"","pno":8047554993,"cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","dob":"1960-02-17"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F41.9","I10","Z79.899","Z12.31","Z68.28","R13.10","L30.9","Z68.29","Z76.89","Z01.411","Z12.39","N64.59","N95.2","R68.89","R05","R09.89","J10.1","R91.8","M75.82","M75.02","          "],"date":["2019-09-18","2020-08-10","2019-09-18","2019-12-26","2020-02-25","2019-09-18","2019-09-18","2019-12-18","2019-09-23","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-08-18","2020-08-18","2020-08-18"]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Screenings Needed","q":[[["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","Select","",false,""],["Select","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":{"comment":"","sub":[["2020-10-04","13107008305","LORAZEPAM","TAB 0.5MG   ","60","Select","Select",""],["2020-11-04","50228014610","HYDROCHLOROT","CAP 12.5MG   ","30","Select","Select",""],["2020-03-09","68462053253","CLOBETASOL","0.05%","","Select","Select",""],["2020-11-04","13668001005","CITALOPRAM","TAB 20MG   ","30","Select","Select",""],["2019-08-14","58160082311","SHINGRIX","50MCG","","Select","Select",""],["2020-02-13","93310705","AMOXICILLIN","250MG","","Select","Select",""],["2020-06-25","116200116","CHLORHEX GLU","0.12%","","Select","Select",""],["2019-09-03","33332031901","AFLURIA QUAD","2019-20","","Select","Select",""],["2020-09-20","70461032003","FLUCLVX","QUAD INJ 2020-21  ","0.5","Select","Select",""],["2020-06-25","00116200116","CHLORHEX","GLU SOL 0.0012  ","473","Select","Select",""],["2019-09-03","33332031901","AFLURIA","QUAD INJ 2019-20  ","0.5","Select","Select",""]]}},{"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":""}]}]}