{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Troy E Brock","gend":0,"currentgend":"","add":"5 WOODLAWN RD","city":"ROCHESTER","state":"NH","zip":"03867","dob":"1964-06-20","age":"","mstatus":"","insh":"61035858800","cliId":"","pno":"6035023508","cno":"","email":"","ename":"","eno":"","pphy":"Tori A Ferland","ppno":"6038683300","pcpadd":"65 Calef Hwy, Ste 200","pcpcity":"Lee","pcpstate":"NH","pcpzip":"03861","pcpcounty":"","pcpid":"","pcpname":"Wentworth Douglass Physician Corp","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - NH - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 WOODLAWN RD","madd2":"","madd3":"","mcity":"ROCHESTER","mstate":"NH","mzip":"03867","pcpfaxno":"","pcpnpi":"1568033116","currentgendcomment":"","pphycomment":"","uniqueid":"150313250","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","Z114","Z1159","Z0000","Z79899","R7401","K828","I110","I509","I4891","Z7901","I5022","I340","Z131","R748","Z01812","I4811","R7989","R945","K7689","I493","I361","Z23","I5020","L209","R040","N529","R9431","R0602","I5023","M7989","R1013","Z1211","I4729","I071","K759","I872","R21","H903","R2689","H9122","I428","E782","K7460","R7303","F1090","Z789","E7800","K760","D485","L301"],"date":["2026-02-17","2025-03-25","2025-07-16","2025-03-25","2025-03-25","2025-04-08","2025-07-10","2025-06-13","2025-04-23","2025-10-14","2025-12-19","2025-12-19","2025-12-19","2025-07-16","2025-12-19","2025-07-16","2025-12-19","2025-07-17","2025-12-09","2025-07-17","2025-12-19","2025-12-19","2025-10-14","2025-10-14","2025-03-12","2025-08-11","2025-03-12","2025-04-23","2025-04-23","2025-04-23","2025-04-23","2025-11-25","2025-11-25","2025-12-19","2025-06-13","2025-07-17","2025-12-16","2025-12-16","2025-08-26","2025-08-11","2025-08-11","2025-08-07","2025-10-14","2025-10-14","2025-10-14","2025-10-14","2025-10-14","2025-09-17","2025-11-25","2025-12-29","2025-12-29"],"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":[["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","MUPIROCIN","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}