{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter L Trouant","gend":0,"currentgend":"","add":"120 CONANT HILL RD","city":"Meddybemps","state":"ME","zip":"04657","dob":"1940-12-18","age":"","mstatus":"","insh":"10000020346","cliId":"","pno":2072146306,"cno":"","email":"ptrouant@gmail.com","ename":"","eno":"","pphy":"RICHARDSON, WILLIAM B","ppno":2078536001,"pcpadd":"Eastport Health Care Inc,30 Boynton St","pcpcity":"Eastport","pcpstate":"ME","pcpzip":"04631","pcpcounty":"","pcpid":"","pcpname":"EASTPORT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"120 CONANT HILL RD","madd2":"","madd3":"","mcity":"Meddybemps","mstate":"ME","mzip":"04657","pcpfaxno":3158292014,"pcpnpi":1457409617,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6TH0K21AN35","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0001","R319","H401131","N138","I10","R6889","E785","N400","S8991XA","J310","M25552","M419","H35363","S76101A","R310","N281","M7121","Z23","S46911A","W19XXXA","S76111A","M76891","M1711","N401","H9202","Z139","M1612","J101","Z0000","M79604","M7989","R0789","J329","I340","L539","N4289","M25561","S76911A","K5730","N3289","L989","Z87438"],"date":["2024-03-01","2024-03-19","2025-05-07","2025-07-11","2023-08-21","2023-02-14","2025-02-28","2023-06-01","2025-08-12","2025-07-16","2024-06-19","2024-03-19","2024-03-14","2025-06-04","2025-07-11","2024-03-19","2025-06-25","2022-12-01","2025-06-09","2025-06-09","2025-09-03","2025-07-31","2025-07-31","2025-07-11","2025-01-13","2023-02-15","2024-06-13","2025-01-21","2025-03-06","2025-06-09","2025-06-09","2023-05-03","2024-05-20","2024-05-13","2023-01-23","2023-01-23","2025-08-12","2025-06-04","2023-01-22","2023-01-22","2023-05-22","2022-08-08"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","TAMSULOSIN HCL","","","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":""}]}]}