{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Keaton T Clark","gend":0,"add":"12 Oak Cliff Dr","city":"Toccoa","state":"GA","zip":30577,"dob":"1990-10-16","age":"","mstatus":"","insh":1807015001,"cliId":"","pno":7065994103,"cno":"","email":"tkkc2009@gmail.com","ename":"","eno":"","pphy":"Marc Coan","ppno":"","pcpadd":"367 Clear Creek Pkwy","pcpcity":"Lavonia","pcpstate":"GA","pcpzip":"","pcpcounty":"Lavonia","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D72.820","Z79.899","Z00.01","I10","I34.1","G43.009","M45.9","J30.89","Z11.1","Z68.20","F41.9","Z68.1","M45.7","M35.7","R53.83","N52.8","Q23.3","I34.0","R79.89","G47.00"],"date":["2021-05-18","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2021-03-30","2022-01-04","2020-04-28","2021-02-02","2020-10-27","2022-01-04","2022-01-04","2021-02-02","2021-02-02","2021-07-06","2022-01-04","2022-01-04","2020-11-03","2022-01-04","2022-01-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","74055402","HUMIRA(CF)","PEN40MG\/0.4ML","2","Select","Select",""],["","69097083412","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","68180051303","LISINOPRIL","5MGTABLET","30","Select","Select",""],["","68382003416","VENLAFAXINE","HCLER37.5MGCAP","30","Select","Select",""],["","55111029236","SUMATRIPTAN","SUCC50MGTABLET","9","Select","Select",""],["","33332032001","AFLURIA","QUAD2020-21(3YRUP)","0.5","Select","Select",""],["","6483703","PNEUMOVAX","23SYRINGE","0.5","Select","Select",""],["","49281042150","FLUZONE","QUAD2021-2022SYRINGE","0.5","Select","Select",""]]}},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}