{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ETHAN R ALFONSO RAMIREZ","gend":0,"add":"6924 W WEST ROAD","city":"CHESTERFIELD","state":"VA","zip":238328388,"dob":"2018-06-01","age":"","mstatus":"","insh":3232933,"cliId":"","pno":8057087158,"cno":"","email":"","ename":"","eno":"","pphy":"ANDERSON, JAMES","ppno":"","pcpadd":"2500 Pocoshock Pl Ste 104","pcpcity":"North Chesterfield","pcpstate":"VA","pcpzip":232356345,"pcpcounty":"","pcpid":"P0140506","pcpname":"BON SECOURS CHESTERFIELD FAMILY MEDICINE"},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["A87.0","R50.9","G03.9","A87.9","Z00.129","Z23","J21.9","J21.0","E73.9","K59.00","Z00.121","J39.9","R63.5","D64.9","J06.9","R63.0","D50.9","J98.4","J98.8","R06.02","R06.2","M21.70"],"date":["2018-09-22","2018-09-22","2018-09-21","2018-09-24","2020-07-06","2019-06-08","2018-12-17","2018-12-17","2019-06-08","2020-07-06","2019-06-08","2019-06-21","2019-06-21","2019-06-21","2019-06-25","2019-06-25","2019-06-25","2019-06-26","2019-06-26","2019-06-26","2019-06-26","2020-07-17"]}},{"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":[]},{"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":""}]}]}