{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BLAISE W BURCH","gend":0,"add":"403 TAREYTON LANE","city":"PORTSMOUTH","state":"VA","zip":237011246,"dob":"2014-05-29","age":"","mstatus":"","insh":7816939,"cliId":"","pno":7577083439,"cno":"","email":"","ename":"","eno":"","pphy":"HENDRICKS, JEAN E","ppno":"","pcpadd":"171 Kempsville Rd Bldg B","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235024732,"pcpcounty":"","pcpid":"P9307516","pcpname":"TIDEWATER CHILDRENS ASSOCIATES"},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F80.9","F80.1","K59.04","S01.21XA","W01.118A","W22.8XXA","S01.401D","W18.30XD","W22.09XD","S01.411D","F88","R48.2","R46.89","F41.9","J02.9","J11.1","F82","F91.8","A08.4","R19.00","R23.3","R19.8","R41.840","Z00.129","Z68.52","Z71.3","N27.1","J10.1","R50.9","R23.8","R79.1","R04.0","Z00.121","L30.9","Z71.82","S01.01XA","W01.198A","W18.39XA"],"date":["2018-09-05","2019-01-02","2019-08-01","2018-11-14","2018-11-14","2020-09-22","2018-11-15","2018-11-15","2018-11-15","2018-11-19","2019-05-30","2019-05-30","2019-05-30","2019-02-07","2019-02-04","2019-02-04","2019-02-07","2019-02-07","2019-02-25","2019-05-22","2019-05-21","2019-05-21","2019-05-30","2019-06-19","2020-07-23","2020-07-23","2019-08-01","2019-12-04","2019-12-04","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-09-22","2020-09-22","2020-09-22"]}},{"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":[]},{"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":""}]}]}