{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUKIJA MUHAREMOVIC","gend":1,"add":"C\/O INDIRA NALIC                                            ","city":"EARLYSVILLE                   ","state":"VA","zip":"22936-9720","dob":"1950-03-30","age":"","mstatus":"","insh":10053004,"cliId":"","pno":4349781281,"cno":4349781281,"email":"","ename":"","eno":"","pphy":"CALHOUN, ALICE O                                            ","ppno":"","pcpadd":"1800 Timberwood Blvd Ste A,Ste 511","pcpcity":"Charlottesville               ","pcpstate":"VA","pcpzip":229117544,"pcpcounty":"","pcpid":"P0060106","pcpname":"UVA FOREST LAKES HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"525 STONEFIELD CIRCLE                                       ","add3":"","madd1":"C\/O INDIRA NALIC                                            ","madd2":"525 STONEFIELD CIRCLE                                       ","madd3":"","mcity":"EARLYSVILLE                   ","mstate":"VA","mzip":"22936-9720","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.9","Z68.34","R03.0","M25.50","M79.641","K21.9","L71.9","M79.642","B88.0","M25.562","I10","G89.29","M17.0","L82.1","L21.9","D22.9","D22.0","Z20.822","Z20.828","M17.11","M25.561","S89.91XA","M25.369","S83.231A","S83.281A"],"date":["2019-05-07","2019-05-07","2019-05-07","2019-05-07","2019-05-07","2021-10-15","2020-03-04","2019-05-07","2021-08-18","2020-02-07","2020-04-14","2020-04-14","2020-02-07","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2021-06-07","2021-06-07","2021-08-18","2021-10-15","2021-10-05","2021-08-18","2021-10-05","2021-10-05"],"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":[["","49884093547","DICLOFENAC","1%","100","Select","Select",""],["","62175018046","PANTOPRAZOLE","20MG","30","Select","Select",""],["","45802004064","SELENIUM","2.50%","120","Select","Select",""],["","00000000000","","","42.86","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","62175018046","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","45802004064","SELENIUM ","LOT 0.025","120","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}