{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KARLY M WISE","gend":1,"add":"22 SOMERSET DRIVE","city":"WEYERS CAVE","state":"VA","zip":244869999,"dob":"2003-09-21","age":"","mstatus":"","insh":5242441,"cliId":"","pno":9042392539,"cno":"","email":"","ename":"","eno":"","pphy":"BROOKINGS, MICHAEL E","ppno":"","pcpadd":"1140 Keezletown Rd","pcpcity":"Weyers Cave","pcpstate":"VA","pcpzip":244862337,"pcpcounty":"","pcpid":"P0114087","pcpname":"AUGUSTA HEALTH URGENT CARE"},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["J06.9","F40.10","S80.11XA","C71.9","C75.1","Z85.858","Z98.890","J02.9","R05","R19.7","R10.84","A08.4","K52.9","F32.1","N39.0","R35.0","F32.9","F29","Z79.899","H65.193","R11.2","R53.83","R11.11","R11.10","E03.9","Z79.890","Z88.0","Z88.1","E03.8","E23.0","F41.9","M85.80","Z91.89","E23.7","E27.49","F33.9","G43.009","F33.1","F41.1","F33.2","G43.109","M48.50XA","T45.1X5A","M54.5","N92.1","J01.90","M85.88","Z13.820","F15.20","F33.42"],"date":["2019-02-05","2019-09-25","2019-01-15","2020-01-20","2019-01-25","2019-07-22","2019-01-25","2019-01-29","2019-02-05","2019-02-13","2019-03-11","2019-02-13","2019-03-11","2019-04-10","2019-02-22","2019-06-25","2020-05-27","2019-04-24","2019-03-04","2019-03-27","2019-04-19","2019-04-10","2019-04-16","2019-04-16","2019-04-16","2019-04-16","2019-04-16","2019-04-16","2019-05-29","2020-10-09","2020-05-27","2019-11-22","2019-05-29","2019-11-22","2019-05-29","2019-05-29","2020-03-09","2020-05-27","2020-08-27","2020-05-27","2020-03-09","2019-11-22","2019-12-17","2019-11-22","2019-11-22","2019-11-23","2019-12-17","2019-12-17","2020-03-09","2020-08-27"]}},{"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":""}]}]}