{
    "document_id": 12840,
    "page": 2,
    "width_pt": 612,
    "height_pt": 792,
    "rotation": 0,
    "pipeline_version": "paddleocr-vl-1.6+paul-48",
    "engine": "paddleocr_vl",
    "source_run_id": 12951,
    "item_count": 35,
    "counts_by_type": {
        "form_field": 5,
        "formula": 2,
        "heading": 4,
        "list": 3,
        "list_item": 14,
        "text": 7
    },
    "build_ms": 3,
    "items": [
        {
            "id": "p2.1",
            "order": 1,
            "type": "heading",
            "bbox": {
                "l": 70.08,
                "t": 705.12,
                "r": 158.16,
                "b": 693.12
            },
            "text": "MEDICAL HISTORY",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p2.2",
            "order": 2,
            "type": "list",
            "bbox": {
                "l": 69.36,
                "t": 678.96,
                "r": 541.44,
                "b": 585.36
            },
            "text": "",
            "attrs": {
                "item_count": 4
            },
            "children": [
                {
                    "id": "p2.2.1",
                    "order": 3,
                    "type": "list_item",
                    "bbox": {
                        "l": 69.6,
                        "t": 678.96,
                        "r": 540.48,
                        "b": 665.28
                    },
                    "text": "Seizures: ___",
                    "children": [
                        {
                            "id": "p2.2.1.1",
                            "order": 4,
                            "type": "form_field",
                            "bbox": {
                                "l": 72.025,
                                "t": 677.45,
                                "r": 539.1785,
                                "b": 666.45
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Seizures: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p2.2.1"
                            }
                        }
                    ]
                },
                {
                    "id": "p2.2.2",
                    "order": 5,
                    "type": "list_item",
                    "bbox": {
                        "l": 69.84,
                        "t": 652.8,
                        "r": 540.72,
                        "b": 638.4
                    },
                    "text": "Chronic Diseases: ___",
                    "children": [
                        {
                            "id": "p2.2.2.1",
                            "order": 6,
                            "type": "form_field",
                            "bbox": {
                                "l": 72.025,
                                "t": 650.7,
                                "r": 539.1785,
                                "b": 639.7
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Chronic Diseases: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p2.2.2"
                            }
                        }
                    ]
                },
                {
                    "id": "p2.2.3",
                    "order": 7,
                    "type": "list_item",
                    "bbox": {
                        "l": 69.84,
                        "t": 625.68,
                        "r": 541.44,
                        "b": 611.76
                    },
                    "text": "Allergies: ___",
                    "children": [
                        {
                            "id": "p2.2.3.1",
                            "order": 8,
                            "type": "form_field",
                            "bbox": {
                                "l": 72.025,
                                "t": 623.7,
                                "r": 540.4285,
                                "b": 612.7
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Allergies: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p2.2.3"
                            }
                        }
                    ]
                },
                {
                    "id": "p2.2.4",
                    "order": 9,
                    "type": "list_item",
                    "bbox": {
                        "l": 69.36,
                        "t": 599.04,
                        "r": 539.76,
                        "b": 585.36
                    },
                    "text": "Medications: ___",
                    "children": [
                        {
                            "id": "p2.2.4.1",
                            "order": 10,
                            "type": "form_field",
                            "bbox": {
                                "l": 72.025,
                                "t": 596.92,
                                "r": 538.3486,
                                "b": 585.92
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Medications: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p2.2.4"
                            }
                        }
                    ]
                }
            ]
        },
        {
            "id": "p2.3",
            "order": 11,
            "type": "heading",
            "bbox": {
                "l": 69.84,
                "t": 571.44,
                "r": 222.96,
                "b": 558.48
            },
            "text": "Significant Historical Information:",
            "level": 3
        },
        {
            "id": "p2.4",
            "order": 12,
            "type": "text",
            "bbox": {
                "l": 70.32,
                "t": 556.56,
                "r": 540,
                "b": 544.56
            },
            "text": "[p2.4.2]",
            "children": [
                {
                    "id": "p2.4.1",
                    "order": 13,
                    "type": "form_field",
                    "bbox": {
                        "l": 72.025,
                        "t": 556.67,
                        "r": 538.1096,
                        "b": 545.67
                    },
                    "text": "",
                    "attrs": {
                        "field_kind": "text",
                        "source": "blank_line"
                    }
                },
                {
                    "id": "p2.4.2",
                    "order": 14,
                    "type": "text",
                    "bbox": {
                        "l": 70.32,
                        "t": 556.56,
                        "r": 540,
                        "b": 544.56
                    },
                    "text": "1/2",
                    "attrs": {
                        "inline": true,
                        "text_offset": 0,
                        "text_span": 8,
                        "bbox_estimated": true
                    }
                }
            ]
        },
        {
            "id": "p2.5",
            "order": 15,
            "type": "heading",
            "bbox": {
                "l": 69.84,
                "t": 531.84,
                "r": 309.12,
                "b": 518.4
            },
            "text": "Required complete immunizations to submit:",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p2.6",
            "order": 16,
            "type": "list",
            "bbox": {
                "l": 86.88,
                "t": 518.9549999999999,
                "r": 529.68,
                "b": 356.88
            },
            "text": "",
            "attrs": {
                "item_count": 7
            },
            "children": [
                {
                    "id": "p2.6.1",
                    "order": 17,
                    "type": "list_item",
                    "bbox": {
                        "l": 87.12,
                        "t": 518.9549999999999,
                        "r": 190.8,
                        "b": 504.72
                    },
                    "text": "Polio Series (x4)",
                    "marker": "•"
                },
                {
                    "id": "p2.6.2",
                    "order": 18,
                    "type": "list_item",
                    "bbox": {
                        "l": 87.12,
                        "t": 496.705,
                        "r": 285.84,
                        "b": 482.16
                    },
                    "text": "Adult Tdap (not older than 10 years)",
                    "marker": "•"
                },
                {
                    "id": "p2.6.3",
                    "order": 19,
                    "type": "list_item",
                    "bbox": {
                        "l": 87.36,
                        "t": 474.205,
                        "r": 529.68,
                        "b": 446.16
                    },
                    "text": "Meningitis Vaccine (up to age 26) – Meningococcal Quadrivalent (A, C, Y, W-135) and Serogroup B Meningococcal Vaccine"
                },
                {
                    "id": "p2.6.4",
                    "order": 20,
                    "type": "list_item",
                    "bbox": {
                        "l": 87.12,
                        "t": 438.185,
                        "r": 345.84,
                        "b": 423.6
                    },
                    "text": "Mumps (MMR x 2 or documentation of disease) [p2.6.4.1]",
                    "marker": "•",
                    "children": [
                        {
                            "id": "p2.6.4.1",
                            "order": 21,
                            "type": "text",
                            "bbox": {
                                "l": 87.12,
                                "t": 438.185,
                                "r": 345.84,
                                "b": 423.6
                            },
                            "text": "^{*}",
                            "attrs": {
                                "inline": true,
                                "text_offset": 44,
                                "text_span": 10,
                                "bbox_estimated": true
                            }
                        }
                    ]
                },
                {
                    "id": "p2.6.5",
                    "order": 22,
                    "type": "list_item",
                    "bbox": {
                        "l": 87.12,
                        "t": 415.935,
                        "r": 340.08,
                        "b": 401.76
                    },
                    "text": "Varicella Vaccine x 2 or History of Chickenpox [p2.6.5.1]",
                    "marker": "•",
                    "children": [
                        {
                            "id": "p2.6.5.1",
                            "order": 23,
                            "type": "formula",
                            "bbox": {
                                "l": 87.12,
                                "t": 415.935,
                                "r": 340.08,
                                "b": 401.76
                            },
                            "text": "^{*}",
                            "attrs": {
                                "latex": "^{*}",
                                "inline": true,
                                "text_offset": 47,
                                "text_span": 10,
                                "bbox_estimated": true,
                                "notation": "latex",
                                "alt": "to the power of *",
                                "mathml": "<math aria-label=\"to the power of *\" xmlns=\"http://www.w3.org/1998/Math/MathML\" display=\"inline\"><mrow><msup><mi /><mrow><mo>&#x0002A;</mo></mrow></msup></mrow></math>"
                            }
                        }
                    ]
                },
                {
                    "id": "p2.6.6",
                    "order": 24,
                    "type": "list_item",
                    "bbox": {
                        "l": 86.88,
                        "t": 393.435,
                        "r": 406.56,
                        "b": 379.2
                    },
                    "text": "Tuberculin Skin Test (INTERNATIONAL STUDENTS ONLY)"
                },
                {
                    "id": "p2.6.7",
                    "order": 25,
                    "type": "list_item",
                    "bbox": {
                        "l": 87.12,
                        "t": 370.935,
                        "r": 215.28,
                        "b": 356.88
                    },
                    "text": "Hepatitis B Series x 3",
                    "marker": "•"
                }
            ]
        },
        {
            "id": "p2.7",
            "order": 26,
            "type": "text",
            "bbox": {
                "l": 71.28,
                "t": 348.48,
                "r": 537.36,
                "b": 336
            },
            "text": "[p2.7.1]Note: Documentation of disease should be verified or signed on physician's/clinic's letterhead.",
            "children": [
                {
                    "id": "p2.7.1",
                    "order": 27,
                    "type": "formula",
                    "bbox": {
                        "l": 71.28,
                        "t": 348.48,
                        "r": 537.36,
                        "b": 336
                    },
                    "text": "^{*}",
                    "attrs": {
                        "latex": "^{*}",
                        "inline": true,
                        "text_offset": 0,
                        "text_span": 8,
                        "bbox_estimated": true,
                        "notation": "latex",
                        "alt": "to the power of *",
                        "mathml": "<math aria-label=\"to the power of *\" xmlns=\"http://www.w3.org/1998/Math/MathML\" display=\"inline\"><mrow><msup><mi /><mrow><mo>&#x0002A;</mo></mrow></msup></mrow></math>"
                    }
                }
            ]
        },
        {
            "id": "p2.8",
            "order": 28,
            "type": "text",
            "bbox": {
                "l": 70.32,
                "t": 335.28,
                "r": 539.28,
                "b": 322.32
            },
            "text": "Note: Documentation from Physician and Parent – NO Immunizations because of religion"
        },
        {
            "id": "p2.9",
            "order": 29,
            "type": "heading",
            "bbox": {
                "l": 70.08,
                "t": 310.8,
                "r": 262.8,
                "b": 298.08
            },
            "text": "Recommended immunizations include:",
            "level": 3
        },
        {
            "id": "p2.10",
            "order": 30,
            "type": "list",
            "bbox": {
                "l": 87.36,
                "t": 298.155,
                "r": 224.16,
                "b": 257.52
            },
            "text": "",
            "attrs": {
                "item_count": 3
            },
            "children": [
                {
                    "id": "p2.10.1",
                    "order": 31,
                    "type": "list_item",
                    "bbox": {
                        "l": 87.36,
                        "t": 298.155,
                        "r": 205.92,
                        "b": 284.16
                    },
                    "text": "Hepatitis A Vaccine",
                    "marker": "•"
                },
                {
                    "id": "p2.10.2",
                    "order": 32,
                    "type": "list_item",
                    "bbox": {
                        "l": 88.08,
                        "t": 284.635,
                        "r": 174.96,
                        "b": 270.96
                    },
                    "text": "HPV Vaccine",
                    "marker": "•"
                },
                {
                    "id": "p2.10.3",
                    "order": 33,
                    "type": "list_item",
                    "bbox": {
                        "l": 87.84,
                        "t": 271.135,
                        "r": 224.16,
                        "b": 257.52
                    },
                    "text": "Pneumococcal Vaccine",
                    "marker": "•"
                }
            ]
        },
        {
            "id": "p2.11",
            "order": 34,
            "type": "text",
            "bbox": {
                "l": 69.84,
                "t": 235.68,
                "r": 531.36,
                "b": 209.28
            },
            "text": "Must submit certificate from Doctor's office/clinic as documentation of proof of all immunizations to address or fax number on front."
        },
        {
            "id": "p2.12",
            "order": 35,
            "type": "text",
            "bbox": {
                "l": 488.4,
                "t": 93.6,
                "r": 540.72,
                "b": 79.68
            },
            "text": "(Rev 6/19)",
            "attrs": {
                "block_label": "number"
            }
        }
    ],
    "excluded_furniture": {
        "first": [],
        "last": []
    }
}