{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jerry N Bracy","gend":0,"currentgend":"","add":"291 MOUNTAIN RD","city":"CAPE NEDDICK","state":"ME","zip":"03902","dob":"1951-03-14","age":"","mstatus":"","insh":"10000084318","cliId":"","pno":2073611008,"cno":"","email":"jerry_n@mail.com","ename":"","eno":"","pphy":"CORBETT, SANDRA L","ppno":"","pcpadd":"127 LONG SANDS RD,SUITE 11","pcpcity":"YORK","pcpstate":"ME","pcpzip":"39091158","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"291 MOUNTAIN RD","madd2":"","madd3":"","mcity":"CAPE NEDDICK","mstate":"ME","mzip":"03902","pcpfaxno":2073513006,"pcpnpi":1417910019,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1MF8WJ4NG47","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":["M069","R053","J479","R911","I10","S22082A","I083","Z136","R9720","Z0000","H903","M450","S22089D","R600","Z23","R339","Z79899","S32019A","S32029A","S32039A","R296","M546","M549","Z48811","M25562","R9389","J449","S22089A","M459","W1830XA","M5450","J984","S22088A","S22089S","S32009A","S22009A","R531","N4289","N3289","K5730","K6389","H40013","M4314","Z0101","J8410","R918","M1712","I700","Z1211","Z8371","H35371","H5203","Z981","M454","S72009A","H2513","H43821","S5011XA","B351","E559"],"date":["2025-08-15","2025-10-29","2025-10-29","2025-10-29","2025-09-25","2024-12-09","2024-12-10","2025-08-05","2025-11-05","2023-10-10","2024-02-08","2025-04-03","2024-12-19","2024-12-09","2025-08-15","2025-11-12","2025-08-15","2024-12-09","2024-12-09","2024-12-09","2024-12-09","2024-12-09","2024-12-09","2025-02-05","2025-11-13","2024-10-28","2025-09-25","2024-12-11","2024-12-11","2024-12-11","2024-12-09","2025-10-11","2024-12-09","2024-12-19","2024-12-09","2024-12-09","2024-12-09","2024-09-20","2024-09-20","2024-09-20","2024-09-20","2025-10-28","2024-12-12","2025-10-28","2025-10-11","2025-10-11","2025-11-13","2024-10-28","2023-01-26","2023-01-26","2024-10-21","2023-10-18","2025-02-05","2024-12-09","2024-12-09","2022-10-12","2022-10-12","2022-10-17","2022-09-27","2022-09-27"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","INDOMETHACIN ER","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}