{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY DANIELS","gend":1,"add":"109 BRADY DR APT 8","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1981-07-07","age":"","mstatus":"","insh":"1807940*01","cliId":"","pno":"757\/966-8194","cno":"757\/966-8194","email":"","ename":"","eno":"","pphy":"FEROZE, AMNA H MD","ppno":"757\/345-0011","pcpadd":"7364 RICHMOND RD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Primary Care Norge","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-0381","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D86.0","Z79.52","J45.40","Z87.891","G47.10","R11.2","G47.33","D86.89","NO DATA","I25.10","I11.0","I50.32","G40.909","M81.8","G89.4","M54.16","F32.9","E66.01","Z68.43","R10.13","G89.29","E87.2","Z51.5","E11.65","R74.8","R73.9","R07.9","R06.89","R00.0","R11.0","R06.02","R06.9","J18.9","R05.","D86.3","M47.816","F17.210","E11.9","F41.8","K76.0","Z87.01","Z79.4","Z79.899","R10.84","H46.9","E24.9","H40.9","R65.10","J45.909","D86.9","V58.89","L03.313","Z86.14","D84.9","R07.89","A41.9","R78.81","R79.89","I50.33","J45.21","J44.1","J44.0","E23.0","Z20.822","T38.0X5A","Z09.","F41.9","M21.371","L03.311","J44.9","L03.90","R10.9","E11.40","F33.41","M51.37","E55.9","L98.9","K44.9","R09.02","J96.01","I10.","K21.9","B34.8","K59.1","M25.551","R10.11","K52.9","D72.829","M54.5","R51.","K62.5","D72.825","R19.7","Z20.828","F41.1","I50.9","E78.5","R21.","J45.50","M19.90","M54.9","R50.9","G89.18","H53.8","Z53.21","H57.13","N39.0","T80.219A","Z86.2","Z45.2","T81.30XA","E53.8","R10.12","R53.81","R51.9","R53.83","Z86.711","Z88.0","Z88.5","Z88.6","Z91.040","Z91.013","Z91.018","E11.8","Z87.19","Z87.11","T45.1X5A","M79.604","R94.5","J10.00","Z53.29","N83.201","R11.10","R00.2","Z71.6","F17.200","M25.50","Z99.3","T82.848A","F11.23","H53.2","H40.053","H47.333","H40.1132","H04.121","H04.122","T80.212A","T82.7XXA","B95.7","K86.1","R65.20","R20.0","R29.898","J20.9","G43.809","A49.1","Z16.21","D64.9","Z00.00","L02.211","R53.1","R81.","R80.9","R82.4","R74.01","G90.50","R10.31","E13.65","R29.818","R20.2","J45.41","Z86.79","Z79.84","R10.10","J10.1","E11.69","L24.89","Z76.0","E66.9","K58.9","F42.9","Z90.49","D86.81","F41.0","G62.9","H57.10","H54.7","H53.483","Z79.51","J45.20","Z80.1","I33.0","L76.21","A41.1","M62.81","M51.04","L03.319","L02.219","K29.70","K64.4","R06.09","M51.36","R26.2","M79.7","M47.812","B34.9","R91.8","E24.2","M79.605","Z79.891","Z51.81","Z98.890","K08.89","K92.1","D86.85","E23.3","T38.3X5A","D35.2","T85.09XA","I49.9","G47.00","Z71.89","E86.0","R74.02","R52.","V58.69","Z91.14","E83.42","R93.89","R26.9","R11.11","T38.815A","R60.9","Z71.2","K20.90","Z99.89","K59.00","R89.9","R10.32","R73.09","F43.0","I50.30","L03.113","J18.8","F11.20","B35.6","L03.114","G47.30","R50.81","B37.9","E87.6","M79.602","F11.90","J96.11","J84.9","R10.30","Z86.018","Z20.9","J96.10","L53.9","L93.0","K58.0","J98.4","R16.1","R06.82","R06.00","M79.89","R42.","Z86.718"],"date":["2021-09-20","2021-09-09","2021-08-29","2021-09-07","2020-07-30","2021-09-18","2021-03-14","2021-09-09","2021-09-20","2021-09-20","2021-09-20","2021-08-31","2021-08-27","2021-01-06","2021-08-31","2021-01-20","2021-08-31","2021-09-07","2021-09-07","2021-07-19","2021-07-01","2021-08-31","2020-12-22","2021-09-20","2021-04-29","2021-08-26","2021-08-09","2021-08-23","2021-09-20","2021-08-26","2021-09-20","2021-09-20","2021-08-27","2021-09-18","2021-08-27","2020-12-16","2020-12-18","2021-09-20","2021-06-30","2021-09-20","2021-09-20","2021-09-07","2021-09-07","2021-09-18","2021-02-07","2021-02-06","2021-07-01","2021-02-20","2021-08-25","2021-09-18","2021-03-18","2021-03-22","2021-09-09","2021-09-09","2021-06-21","2021-08-31","2021-03-22","2021-08-19","2021-04-05","2021-04-01","2021-07-01","2021-06-21","2021-04-28","2021-09-18","2021-08-27","2021-04-14","2021-08-16","2021-04-14","2021-09-09","2021-09-20","2021-08-16","2021-08-25","2021-06-04","2021-08-25","2021-07-01","2021-07-01","2021-05-27","2021-06-12","2021-08-31","2021-06-30","2021-06-30","2021-09-20","2021-06-26","2020-05-06","2021-04-08","2021-03-29","2021-01-25","2020-12-16","2021-01-06","2020-08-03","2020-09-05","2020-09-05","2021-07-19","2021-01-03","2021-08-25","2021-09-20","2021-09-07","2020-12-05","2020-12-30","2020-12-23","2021-01-25","2021-09-20","2021-01-17","2021-02-12","2021-02-09","2021-04-11","2021-02-23","2021-03-22","2021-03-09","2021-03-08","2021-03-20","2021-03-30","2021-05-10","2021-05-27","2021-05-27","2021-08-10","2021-09-09","2021-09-07","2021-09-07","2021-05-27","2021-07-24","2021-07-24","2021-07-24","2021-06-30","2021-07-19","2021-09-20","2020-07-24","2021-02-05","2020-10-27","2020-11-26","2021-02-16","2020-11-26","2021-09-20","2020-12-09","2020-12-09","2020-12-09","2021-04-02","2021-01-04","2021-02-05","2021-02-06","2021-02-12","2021-02-06","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-03-10","2021-03-22","2021-03-22","2021-03-22","2021-08-29","2021-04-08","2021-04-08","2021-06-04","2020-08-02","2021-02-24","2021-02-24","2021-03-15","2021-04-23","2021-04-28","2021-08-10","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-02-07","2021-09-09","2021-03-18","2021-09-18","2021-04-08","2020-08-07","2020-08-23","2020-08-31","2020-09-11","2020-11-16","2020-11-16","2021-01-14","2021-01-18","2021-09-09","2021-01-18","2021-09-18","2021-09-07","2021-01-24","2021-08-25","2021-01-24","2021-02-11","2021-02-11","2021-02-11","2021-02-21","2021-02-21","2021-02-21","2021-03-16","2021-03-11","2021-03-15","2021-04-08","2021-04-08","2021-04-30","2021-04-30","2020-11-03","2020-05-06","2021-03-14","2021-08-25","2020-06-12","2021-09-09","2020-06-15","2020-11-23","2021-08-02","2020-12-12","2021-08-28","2021-01-20","2021-01-20","2021-01-20","2020-08-07","2020-09-04","2021-02-16","2020-12-19","2020-12-19","2020-12-19","2021-02-05","2021-03-30","2020-10-07","2021-09-11","2020-10-13","2021-09-09","2021-08-26","2020-12-10","2020-12-10","2020-12-22","2020-12-22","2021-04-20","2021-05-14","2021-03-29","2021-09-01","2021-06-14","2021-07-17","2020-10-07","2020-10-15","2021-09-27","2020-11-03","2020-11-03","2021-03-14","2021-03-14","2021-08-02","2021-06-21","2021-08-31","2021-07-30","2021-07-24","2021-09-20","2021-08-09","2021-08-11","2021-08-11","2021-07-20","2021-07-20","2021-08-31","2021-08-27","2021-08-27","2021-09-09","2021-09-09","2021-08-29","2021-08-29","2021-08-29","2021-08-13","2021-09-18","2021-09-18","2021-08-24","2021-09-20","2021-08-28","2021-09-20","2021-09-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"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":[["","54436001504","OTREXUP ","15MG","4","Select","Select",""],["","59746017206","PREDNISONE ","5MG","90","Select","Select",""],["","60505265401","TRAZODONE ","100MG","60","Select","Select",""],["","59762219803","AZITHROMYCIN ","250MG","6","Select","Select",""],["","42858010401","OXYCOD\/APAP ","10-325MG","28","Select","Select",""],["","59148003713","REXULTI ","1MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","15","Select","Select",""],["","00378932232","WIXELA ","500\/50","60","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","20","Select","Select",""],["","08290309592","3ML ","25GX5\/8\"","30","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00591555501","PROPRANOLOL ","20MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","30","Select","Select",""],["","67877056105","METFORMIN ","500MG","180","Select","Select",""],["","00193725201","CONTOUR ","NEXT EZ","1","Select","Select",""],["","16729017101","AMITRIPTYLIN ","10MG","30","Select","Select",""],["","27808008601","HYD ","10-8\/5ML","140","Select","Select",""],["","00597016061","SPIRIVA ","1.25MCG","4","Select","Select",""],["","43598032675","CIPRO\/DEXA ","0.3-0.1%","8","Select","Select",""],["","45802086802","POLYETH ","3350 NF","476","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","43547034703","PAROXETINE ","10MG","30","Select","Select",""],["","00904645760","DOK ","100MG","60","Select","Select",""],["","00093220305","METOCLOPRAM ","10MG","1","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","69097081307","GABAPENTIN ","100MG","90","Select","Select",""],["","27241009903","DULOXETINE ","60MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","47781042447","FENTANYL ","25MCG\/HR","10","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","6","Select","Select",""],["","70710112307","DOXYCYC ","100MG","20","Select","Select",""],["","65162074510","PROMETHAZINE ","12.5MG","30","Select","Select",""],["","77333098310","ZINC ","220MG","30","Select","Select",""],["","61703035038","METHOTREXATE ","25MG\/ML","8","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","00173088210","BREO ","200-25","60","Select","Select",""],["","31722072320","LEVOFLOXACIN ","750MG","7","Select","Select",""],["","00591299239","PHENADOZ ","25MG","5","Select","Select",""],["","69315012701","FOLIC ","1000MCG","30","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","59011075104","BUTRANS ","10MCG\/HR","4","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","65162003310","APAP\/CODEINE ","300-30MG","60","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","1","Select","Select",""],["","68462011944","FLUCONAZOLE ","150MG","2","Select","Select",""],["","11822729260","","","30","Select","Select",""],["","00143962125","CYANOCOBALAM ","1000MCG","1","Select","Select",""],["","00173069700","ADVAIR ","500\/50","60","Select","Select",""],["","00121086816","NYSTATIN ","100000","280","Select","Select",""],["","68382039801","POT  CHLORIDE","20MEQ ER","30","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","60","Select","Select",""],["","69238149001","BUMETANIDE ","1MG","30","Select","Select",""],["","16714065202","CIPROFLOXACN ","500MG","14","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","28","Select","Select",""],["","00065853302","CIPRODEX ","0.3-0.1%","8","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","20","Select","Select",""],["","33342029907","ESZOPICLONE ","1MG","30","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","15","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","12","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","24","Select","Select",""],["","11822393550","RA ","","476","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","30","Select","Select",""],["","08471054701","ANTI-NAUSEA ","GINGER","24","Select","Select",""],["","10702005601","OXYCODONE ","10MG","180","Select","Select",""],["","00832046515","NYAMYC ","100000","45","Select","Select",""],["","00378247401","DICLOFEN ","50MG","30","Select","Select",""],["","59762005001","METHYLPRED ","16MG","14","Select","Select",""],["","00904530760","BANOPHEN ","50MG","30","Select","Select",""],["","00185064901","DIPHENHYDRAM ","50MG","30","Select","Select",""],["","59385002160","BELBUCA ","75MCG","30","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","8","Select","Select",""],["","08627005303","DEXCOM ","SENSOR","1","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","08290309623","1ML ","27GX1\/2\"","12","Select","Select",""],["","62332002231","FLUOXETINE ","10MG","90","Select","Select",""],["","77333080050","SACCHAROMYCE ","BOULARDI","60","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","14","Select","Select",""],["","69238120302","BUPRENORPHIN ","10MCG\/HR","4","Select","Select",""],["","58657050004","CODEINE\/GG ","10-100\/5","100","Select","Select",""],["","50383023310","DORZOL\/TIMOL ","22.3-6.8","10","Select","Select",""],["","04142000024","FLORASTOR ","250MG","60","Select","Select",""],["","57896086905","PROBIOTIC ","250MG","50","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","28","Select","Select",""],["","69315090510","LORAZEPAM ","1MG","30","Select","Select",""],["","64380071206","BENZONATATE ","100MG","42","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","14","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","14","Select","Select",""],["","16714039102","CEFDINIR ","300MG","10","Select","Select",""],["","08290309592","3ML","25GX5\/8\"","30","Select","Select",""],["","59746017506","PREDNISONE","20MG","30","Select","Select",""],["","00591555501","PROPRANOLOL","20MG","60","Select","Select",""],["","60505265401","TRAZODONE","100MG","60","Select","Select",""],["","42858010401","OXYCOD\/APAP","10-325MG","28","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","59762219803","AZITHROMYCIN","250MG","6","Select","Select",""],["","54436001504","OTREXUP","15MG","4","Select","Select",""],["","00904645760","DOK","100MG","60","Select","Select",""],["","00093220305","METOCLOPRAM","10MG","1","Select","Select",""],["","50228018005","GABAPENTIN","300MG","90","Select","Select",""],["","61703035038","METHOTREXATE","25MG\/ML","8","Select","Select",""],["","27241009903","DULOXETINE","60MG","30","Select","Select",""],["","55111015330","ONDANSETRON","4MG","20","Select","Select",""],["","00378932232","WIXELA","500\/50","60","Select","Select",""],["","59148003713","REXULTI","1MG","30","Select","Select",""],["","65862057490","MONTELUKAST","10MG","90","Select","Select",""],["","00591299239","PHENADOZ","25MG","5","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","70010049101","METFORMIN","500MG ER","30","Select","Select",""],["","65162036110","FOLIC","1MG","30","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","70710112307","DOXYCYC","100MG","20","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","60","Select","Select",""],["","00173088210","BREO","200-25","60","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","00527058601","DICYCLOMINE","10MG","28","Select","Select",""],["","16714065202","CIPROFLOXACN","500MG","14","Select","Select",""],["","68382039801","POT CHLORIDE","20MEQ ER","30","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","20","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00143962125","CYANOCOBALAM","1000MCG","3","Select","Select",""],["","62542030104","HYD","10-8\/5ML","70","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","30","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","4","Select","Select",""],["","70010077001","METHOCARBAM","750MG","24","Select","Select",""],["","16729017101","AMITRIPTYLIN","10MG","30","Select","Select",""],["","33342029907","ESZOPICLONE","1MG","30","Select","Select",""],["","43598032675","CIPRO\/DEXA","0.3-0.1%","8","Select","Select",""],["","53885039310","ONETOUCH","LANCETS","200","Select","Select",""],["","00597016061","SPIRIVA","1.25MCG","4","Select","Select",""],["","00065853302","CIPRODEX","0.3-0.1%","8","Select","Select",""],["","00193725201","CONTOUR","NEXT EZ","1","Select","Select",""],["","43547034703","PAROXETINE","10MG","30","Select","Select",""],["","10702005601","OXYCODONE","10MG","180","Select","Select",""],["","08471054701","ANTI-NAUSEA","GINGER","24","Select","Select",""],["","11822393550","RA","","476","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","45","Select","Select",""],["","00185064901","DIPHENHYDRAM","50MG","30","Select","Select",""],["","59762005101","METHYLPRED","32MG","2","Select","Select",""],["","00378247401","DICLOFEN","50MG","30","Select","Select",""],["","77333098310","ZINC","220MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","5","Select","Select",""],["","00904530760","BANOPHEN","50MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","47781042447","FENTANYL","25MCG\/HR","10","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","6","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","08627005303","DEXCOM","SENSOR","1","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","00832046515","NYAMYC","100000","45","Select","Select",""],["","59385002160","BELBUCA","75MCG","30","Select","Select",""],["","62332002231","FLUOXETINE","10MG","90","Select","Select",""],["","00406324301","HYDROMORPHON","2MG","8","Select","Select",""],["","08290309623","1ML","27GX1\/2\"","12","Select","Select",""],["","65162003310","APAP\/CODEINE","300-30MG","30","Select","Select",""],["","50383023310","DORZOL\/TIMOL","22.3-6.8","10","Select","Select",""],["","69238149001","BUMETANIDE","1MG","30","Select","Select",""],["","59011075104","BUTRANS","10MCG\/HR","4","Select","Select",""],["","69238120302","BUPRENORPHIN","10MCG\/HR","4","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","00002879959","HUMALOG","100\/ML","15","Select","Select",""],["","04142000024","FLORASTOR","250MG","60","Select","Select",""],["","57896086905","PROBIOTIC","250MG","50","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","1","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","28","Select","Select",""],["","00121086816","NYSTATIN","100000","280","Select","Select",""],["","64380071206","BENZONATATE","100MG","42","Select","Select",""],["","65162047810","NITROFURANTN","100MG","14","Select","Select",""],["","67877021620","CEFUROXIME","500MG","14","Select","Select",""],["","69315090510","LORAZEPAM","1MG","90","Select","Select",""],["","58657050004","CODEINE\/GG","10-100\/5","100","Select","Select",""],["","16714039102","CEFDINIR","300MG","10","Select","Select",""],["","69238110005","DOXYCYCL","100MG","10","Select","Select",""],["","08489830910","PEN NEEDLES","31GX8MM","200","Select","Select",""],["","31722054301","INDOMETHACIN","50MG","90","Select","Select",""],["","77333080050","SACCHAROMYCE","BOULARDI","60","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":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"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":"","a12":""}]}]}