{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY CASPER","gend":1,"add":"519 N 21ST ST APT A","city":"HENRICO","state":"VA","zip":232239999,"age":"","mstatus":"","insh":22027073101,"cliId":"","pno":7035086154,"cno":"","email":"ASHJCASPER@GMAIL.COM","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","dob":"1994-05-22"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["S52.502A","S52.502D","M25.332","M62.81","Z87.81","Z13.220","Z00.00","Z68.20","L91.8","M25.552","F33.0","N39.0","          "],"date":["2019-01-03","2019-03-12","2019-02-19","2019-02-19","2019-02-19","2019-09-06","2019-09-06","2019-10-11","2019-09-06","2019-09-06","2019-11-05","2019-10-11","2019-11-05"]}},{"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":[["2020-07-22","59746000103","METHYLPRED","4MG","","Select","Select",""],["2020-07-22","45802002146","BETAMETH DIP","0.05%","","Select","Select",""],["2019-11-13","70461031903","FLUCLVX QUAD","2019-20","","Select","Select",""],["2019-10-11","65862007601","CIPROFLOXACN","250MG","","Select","Select",""],["2020-07-22","45802002146","BETAMETH","DIP LOT 0.0005  ","60","Select","Select",""],["2020-11-12","70461032003","FLUCLVX","QUAD INJ 2020-21  ","0.5","Select","Select",""],["2020-11-30","65862053650","LEVOFLOXACIN","TAB 250MG   ","7","Select","Select",""],["2020-11-12","68180012202","CEPHALEXIN","CAP 500MG   ","28","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":""}]}]}