{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lacianne Elouidor","gend":1,"currentgend":"","add":"91 Locust St","city":"Brockton","state":"MA","zip":"02301","dob":"1982-07-25","age":"","mstatus":"","insh":"C0027756200","cliId":"","pno":"3475628243","cno":"","email":"","ename":"","eno":"","pphy":"Shrein  Saini","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":"91 Locust St","madd2":"","madd3":"","mcity":"Brockton","mstate":"MA","mzip":"02301","pcpfaxno":"","pcpnpi":"1235580259","currentgendcomment":"","pphycomment":"","uniqueid":"134065600","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","N978","Z319","N979","N83201","D219","E559","N83202","Z148","Z1231","Z3202","R202","M542","M25519","E049","N840","Z124","N760","E041","Z789","R102","E663","Z2839","Z6828","Z31430","Z114","Z1159","Z13228","N83291","N83292","R9389","N946","Z23","Z713","Z7182","R87612","N898","Z09","D573","K603","L928","K6030","Z01419","Z01818","D563","D259","N858","G4733","G4730","J310","K117","R92333","H52223","H04123","H524"],"date":["2026-05-26","2026-04-28","2026-04-28","2025-07-02","2025-11-03","2026-04-28","2026-03-25","2025-11-03","2026-04-28","2026-04-28","2026-03-26","2026-03-26","2026-03-26","2026-03-26","2025-01-15","2025-02-05","2025-05-21","2025-01-15","2025-03-31","2025-03-05","2025-03-10","2025-03-05","2025-02-26","2025-02-26","2025-01-15","2025-03-05","2025-03-05","2025-03-05","2025-03-10","2025-03-10","2025-06-11","2025-03-24","2025-05-08","2025-04-08","2025-04-08","2025-05-21","2025-05-21","2025-06-11","2025-05-28","2024-09-04","2024-09-04","2024-11-06","2025-02-05","2025-01-21","2025-05-28","2025-06-11","2025-06-11","2024-07-10","2024-12-11","2024-12-11","2024-12-11","2024-09-11","2024-12-04","2024-12-04","2024-12-04"],"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":[["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLOMIPHENE CITRATE","","","Select","Select",""],["","","CLASSIC PRENATAL","","","Select","Select",""],["","","IBUPROFEN","","","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":""}]}]}