{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EID RUSTOM","gend":0,"add":"9400 COLESON RD","city":"GLEN ALLEN","state":"VA","zip":"230609999","dob":"1961-03-28","age":"","mstatus":"","insh":"22027345201","cliId":"","pno":"5402501212","cno":"","email":"ABURAPHEL@YAHOO.COM","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["S76.111A","M25.461","M17.11","R10.11","E78.2","R73.03","R53.83","N52.8","D12.2","K64.8","K62.5","K29.70","K31.7","K29.80","K92.1","K62.89","Z87.19","R10.13","K21.9","R12"],"date":["2019-04-09","2019-04-09","2019-04-17","2019-08-27","2019-08-27","2019-08-27","2019-08-27","2019-08-27","2019-12-09","2019-12-09","2020-06-22","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2020-04-22","2020-04-06","2020-06-22","2020-06-22","2020-06-22"]}},{"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":[["2020-03-17","65862056099","PANTOPRAZOLE","40MG","","Select","Select",""],["2020-03-17","68001039803","FAMOTIDINE","40MG","","Select","Select",""],["2019-04-10","93005805","TRAMADOL HCL","50MG","","Select","Select",""],["2019-10-21","55111015810","OMEPRAZOLE","20MG","","Select","Select",""],["2019-11-25","43386006019","GAVILYTE-C","","","Select","Select",""],["2019-11-08","70461031903","FLUCLVX QUAD","2019-20","","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":""}]}]}