{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eline Joachim","gend":1,"currentgend":"","add":"51 ADDISON ST","city":"BROCKTON","state":"MA","zip":"02301","dob":"1975-12-01","age":"","mstatus":"","insh":"C0008875300","cliId":"","pno":"5089339836","cno":"","email":"","ename":"","eno":"","pphy":"Shruti  Pathak","ppno":"5085596699","pcpadd":"63 Main St","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Brockton Neighborhood Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"51 ADDISON ST","madd2":"","madd3":"","mcity":"BROCKTON","mstate":"MA","mzip":"02301","pcpfaxno":"","pcpnpi":"1124301304","currentgendcomment":"","pphycomment":"","uniqueid":"68290550","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Creoles & Pidgin (FRE)"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1165","R99","R079","R9431","E113292","I10","E7800","F4323","Z634","H2513","H5213","H52203","H2511","H524","Z0000","R928","N6314","F419","H2589","Z1239","H25812","Z760","Z3169","R140","Z111","E113299","Z1211","R7611","Z3202","E13649","Z30011","H40053","E119","H269","H04123","N911","R030","E66811","Z713","Z7182"],"date":["2026-05-18","2026-05-18","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2025-12-17","2025-12-17","2025-07-07","2025-10-15","2025-10-15","2025-10-15","2025-10-15","2025-12-20","2025-12-17","2025-12-17","2025-12-17","2026-04-28","2026-05-04","2026-04-28","2024-07-16","2024-10-01","2024-09-13","2024-07-16","2025-04-17","2024-07-16","2024-07-16","2025-01-27","2024-09-17","2024-10-01","2024-10-24","2024-10-24","2025-03-10","2024-08-30","2025-01-27","2025-06-02","2025-06-02","2025-06-02","2025-06-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","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":[]}]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","PRENATAL VITAMINS","","","Select","Select",""],["","","UNILET LANCETS","","","Select","Select",""],["","","ALCOHOL PREP PADS","","","Select","Select",""],["","","GLIMEPIRIDE","","","Select","Select",""],["","","DIFLUPREDNATE","","","Select","Select",""],["","","BROMFENAC SODIUM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of 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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":""}]}]}