{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERTA FELITTO","gend":1,"add":"4707 AUGUSTA AVE","city":"RICHMOND","state":"VA","zip":232309999,"age":"","mstatus":"","insh":22027732101,"cliId":"","pno":8606255849,"cno":"","email":"RFELITTO1@GMAIL.COM","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","dob":"1956-11-26"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z76.89","Z13.5","Z12.4","Z11.59","Z68.24","Z00.00","M25.511","M47.812","M54.12","M54.2","Z01.419","Z12.31","          ","H43.393","H43.813","H25.89"],"date":["2019-06-21","2019-06-21","2019-06-21","2019-06-21","2019-06-21","2019-11-20","2019-12-10","2019-12-10","2019-12-16","2020-01-17","2020-08-25","2020-09-01","2020-10-21","2020-10-21","2020-10-21","2020-10-21"]}},{"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":[["2019-09-16","70461031903","FLUCLVX QUAD","2019-20","","Select","Select",""],["2019-10-03","58160082311","SHINGRIX","50MCG","","Select","Select",""],["2019-12-10","59746000103","METHYLPRED","4MG","","Select","Select",""],["2019-12-10","591565810","CYCLOBENZAPR","10MG","","Select","Select",""],["2019-12-10","172392670","DIAZEPAM","5MG","","Select","Select",""],["2019-09-16","70461031903","FLUCLVX","QUAD INJ 2019-20  ","0.5","Select","Select",""],["2020-08-09","49281042050","FLUZONE","QUAD INJ 2020-21  ","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":""}]}]}