{
    "section": "subjective",
    "templateSet": "Well Child Visit, 8-9 Years",
    "templates": [
        {
            "text": "(Patient age, years",
            "template": "Patient is a {text} year old",
            "type": "number"
        },
        {
            "text": "Sex",
            "template": "{children}",
            "children": [
                {
                    "text": "male",
                    "template": "male"
                },
                {
                    "text": "female",
                    "template": "female"
                }
            ]
        },
        {
            "text": "Reason for visit)",
            "template": "{children}.",
            "children": [
                {
                    "text": "well child visit\/no acute concerns",
                    "template": "brought in by caregiver for well child visit. Caregiver reports that the child is\n                                developing normally, and there are no acute concerns\n                            "
                },
                {
                    "text": "follow up from prior visit",
                    "template": "brought in by caregiver for follow up from prior visit"
                },
                {
                    "text": "follow up visit from hospital",
                    "template": "brought in by caregiver for follow up visit from hospital"
                },
                {
                    "text": "referred by hospital",
                    "template": "referred by hospital, accompanied by caregiver"
                },
                {
                    "text": "check up for travel",
                    "template": "brought in by caregiver for check up for travel"
                },
                {
                    "text": "school physical exam",
                    "template": "brought in by caregiver for school physical exam"
                },
                {
                    "text": "sports physical exam",
                    "template": "brought in by caregiver for sports physical"
                },
                {
                    "text": "well visit with acute concerns",
                    "template": "brought in by caregiver for well child visit. Caregiver reports concerns related to\n                                child, including {text}\n                            ",
                    "type": "alpha"
                },
                {
                    "text": "other well visit (describe)",
                    "template": "brought in by caregiver for {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Interval History",
            "template": "Patient's caregiver reports the presence\/absence of the following hx\/sx since the\n                        last visit: {children}.\n                    ",
            "children": [
                {
                    "text": "no complaints",
                    "template": "no complaints"
                },
                {
                    "text": "abdominal pain",
                    "template": "abdominal pain",
                    "type": "plus-minus"
                },
                {
                    "text": "congestion",
                    "template": "congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "ear pain",
                    "template": "ear pain",
                    "type": "plus-minus"
                },
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "sore throat",
                    "template": "sore throat",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "weight gain",
                    "template": "weight gain",
                    "type": "plus-minus"
                },
                {
                    "text": "weight loss",
                    "template": "weight loss",
                    "type": "plus-minus"
                },
                {
                    "text": "other history\/sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "congestion",
                    "template": "congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "crying",
                    "template": "crying",
                    "type": "plus-minus"
                },
                {
                    "text": "irritability",
                    "template": "irritability",
                    "type": "plus-minus"
                },
                {
                    "text": "lethargy",
                    "template": "lethargy",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal discharge",
                    "template": "nasal discharge",
                    "type": "plus-minus"
                },
                {
                    "text": "sneezing",
                    "template": "sneezing",
                    "type": "plus-minus"
                },
                {
                    "text": "rash",
                    "template": "rash",
                    "type": "plus-minus"
                },
                {
                    "text": "rhinorrhea",
                    "template": "rhinorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "other pertinent sx (describe)",
                    "template": "other symptoms: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Diet\/Nutrition",
            "template": "Diet\/Nutrition: {children}.",
            "children": [
                {
                    "text": "milk",
                    "template": "milk",
                    "children": [
                        {
                            "text": "whole",
                            "template": "whole"
                        },
                        {
                            "text": "2%",
                            "template": "2%"
                        },
                        {
                            "text": "1%",
                            "template": "1%"
                        },
                        {
                            "text": "nonfat",
                            "template": "nonfat"
                        }
                    ]
                },
                {
                    "text": "milk, amount daily (oz)",
                    "template": "{text} oz milk per day",
                    "type": "number"
                },
                {
                    "text": "water, amount daily (oz)",
                    "template": "{text} oz water per day",
                    "type": "number"
                },
                {
                    "text": "juice, amount daily (oz)",
                    "template": "{text} oz juice per day",
                    "type": "number"
                },
                {
                    "text": "vitamins",
                    "template": "vitamins",
                    "type": "plus-minus"
                },
                {
                    "text": "healthy balanced meals",
                    "template": "healthy balanced meals",
                    "type": "plus-minus"
                },
                {
                    "text": "soda\/sugary drinks",
                    "template": "soda\/sugary drinks",
                    "type": "plus-minus"
                },
                {
                    "text": "energy drinks",
                    "template": "energy drinks",
                    "type": "plus-minus"
                },
                {
                    "text": "fast food, times per week",
                    "template": "fast food {text} times per week",
                    "type": "number"
                },
                {
                    "text": "meal choices\/snacks (specify)",
                    "template": "meal choices\/snacks: {text}",
                    "type": "alpha"
                },
                {
                    "text": "other diet\/nutritional comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Elimination",
            "template": "Elimination: {children}.",
            "children": [
                {
                    "text": "normal urination",
                    "template": "normal urination",
                    "type": "plus-minus"
                },
                {
                    "text": "normal bowel movements",
                    "template": "normal bowel movements",
                    "type": "plus-minus"
                },
                {
                    "text": "pain with urination",
                    "template": "pain with urination",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "color, stool",
                    "template": "stool is {children}",
                    "children": [
                        {
                            "text": "brown",
                            "template": "brown"
                        },
                        {
                            "text": "black",
                            "template": "black"
                        },
                        {
                            "text": "tarry",
                            "template": "tarry"
                        },
                        {
                            "text": "dark red",
                            "template": "dark red"
                        },
                        {
                            "text": "blood-tinged",
                            "template": "blood-tinged"
                        },
                        {
                            "text": "bloody",
                            "template": "bloody"
                        },
                        {
                            "text": "pale",
                            "template": "pale"
                        },
                        {
                            "text": "yellow",
                            "template": "yellow"
                        },
                        {
                            "text": "tan",
                            "template": "tan"
                        },
                        {
                            "text": "green",
                            "template": "green"
                        },
                        {
                            "text": "white\/chalky",
                            "template": "white\/chalky"
                        }
                    ]
                },
                {
                    "text": "consistency, stool",
                    "template": "{children} in consistency",
                    "children": [
                        {
                            "text": "dry, hard",
                            "template": "dry, hard"
                        },
                        {
                            "text": "soft",
                            "template": "soft"
                        },
                        {
                            "text": "lumpy",
                            "template": "lumpy"
                        },
                        {
                            "text": "smooth",
                            "template": "smooth"
                        },
                        {
                            "text": "formed",
                            "template": "formed"
                        },
                        {
                            "text": "mushy",
                            "template": "mushy"
                        },
                        {
                            "text": "liquid",
                            "template": "liquid"
                        },
                        {
                            "text": "thick",
                            "template": "thick"
                        },
                        {
                            "text": "loose",
                            "template": "loose"
                        },
                        {
                            "text": "watery",
                            "template": "watery"
                        },
                        {
                            "text": "mucus",
                            "template": "with mucus"
                        }
                    ]
                },
                {
                    "text": "caliber, stool",
                    "template": "{children} caliber",
                    "children": [
                        {
                            "text": "small caliber",
                            "template": "small"
                        },
                        {
                            "text": "medium caliber",
                            "template": "medium"
                        },
                        {
                            "text": "large caliber",
                            "template": "large"
                        }
                    ]
                },
                {
                    "text": "volume, stool",
                    "template": "{children} volume",
                    "children": [
                        {
                            "text": "small volume",
                            "template": "small"
                        },
                        {
                            "text": "medium volume",
                            "template": "medium"
                        },
                        {
                            "text": "large volume",
                            "template": "large"
                        }
                    ]
                },
                {
                    "text": "frequency (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "other elimination comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Sleep",
            "template": "Sleep: {children}.",
            "children": [
                {
                    "text": "sleep, hours\/night (specify)",
                    "template": "{text} hours of sleep per night",
                    "type": "number"
                },
                {
                    "text": "sleeps through the night",
                    "template": "sleeps through the night",
                    "type": "plus-minus"
                },
                {
                    "text": "night terrors",
                    "template": "night terrors",
                    "type": "plus-minus"
                },
                {
                    "text": "nocturnal enuresis",
                    "template": "nocturnal enuresis",
                    "type": "plus-minus"
                },
                {
                    "text": "sleep walking",
                    "template": "sleep walking",
                    "type": "plus-minus"
                },
                {
                    "text": "other sleep comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Home Environment\/Exposures",
            "template": "Home Environment\/Exposures: {children}.",
            "children": [
                {
                    "text": "seat belt use",
                    "template": "seat belt use",
                    "type": "plus-minus"
                },
                {
                    "text": "pets in home",
                    "template": "pets in home",
                    "type": "plus-minus"
                },
                {
                    "text": "smoking exposure in home",
                    "template": "smoking exposure in home",
                    "type": "plus-minus"
                },
                {
                    "text": "chicken pox exposure",
                    "template": "chicken pox exposure",
                    "type": "plus-minus"
                },
                {
                    "text": "lead exposure",
                    "template": "exposure to lead",
                    "type": "plus-minus"
                },
                {
                    "text": "TB exposure",
                    "template": "TB exposure",
                    "type": "plus-minus"
                },
                {
                    "text": "inhome caregivers (describe)",
                    "template": "lives at home with {text}",
                    "type": "alpha"
                },
                {
                    "text": "family concerns",
                    "template": "family concerns related to",
                    "children": [
                        {
                            "text": "attention",
                            "template": "attention"
                        },
                        {
                            "text": "behavior",
                            "template": "behavior"
                        },
                        {
                            "text": "discipline",
                            "template": "discipline"
                        },
                        {
                            "text": "relationships with parents",
                            "template": "relationships with parents"
                        },
                        {
                            "text": "relationships with siblings",
                            "template": "relationships with siblings"
                        },
                        {
                            "text": "limits",
                            "template": "limits"
                        }
                    ]
                },
                {
                    "text": "other environment\/exposures (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Education",
            "template": "Education: {children}.",
            "children": [
                {
                    "text": "name of school",
                    "template": "attends {text}",
                    "type": "alpha"
                },
                {
                    "text": "school: grade level",
                    "template": "currently studying at the {children} grade level",
                    "children": [
                        {
                            "text": "first",
                            "template": "first"
                        },
                        {
                            "text": "second",
                            "template": "second"
                        },
                        {
                            "text": "third",
                            "template": "third"
                        },
                        {
                            "text": "fourth",
                            "template": "fourth"
                        },
                        {
                            "text": "fifth",
                            "template": "fifth"
                        }
                    ]
                },
                {
                    "text": "childcare\/after school care",
                    "template": "childcare\/after school care",
                    "type": "plus-minus"
                },
                {
                    "text": "school concerns",
                    "template": "caregiver has concerns related to school that include",
                    "children": [
                        {
                            "text": "attention",
                            "template": "attention"
                        },
                        {
                            "text": "discipline",
                            "template": "discipline"
                        },
                        {
                            "text": "failing",
                            "template": "failing"
                        },
                        {
                            "text": "fine motor skills",
                            "template": "fine motor skills"
                        },
                        {
                            "text": "gross motor skills",
                            "template": "gross motor skills"
                        },
                        {
                            "text": "homework",
                            "template": "homework"
                        },
                        {
                            "text": "hyperactivity",
                            "template": "hyperactivity"
                        },
                        {
                            "text": "language problems",
                            "template": "language problems"
                        },
                        {
                            "text": "math problems",
                            "template": "math problems"
                        },
                        {
                            "text": "reading problems",
                            "template": "reading problems"
                        },
                        {
                            "text": "relationships with teachers",
                            "template": "relationships with teachers"
                        },
                        {
                            "text": "relationships with peers",
                            "template": "relationships with peers"
                        },
                        {
                            "text": "speech",
                            "template": "speech"
                        }
                    ]
                },
                {
                    "text": "other school concerns (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Physical Activity\/Social",
            "template": "Physical Activity\/Social: {children}.",
            "children": [
                {
                    "text": "hours of physical activity per day",
                    "template": "{children} physical activity per day",
                    "children": [
                        {
                            "text": "<1 hour",
                            "template": "<1 hour"
                        },
                        {
                            "text": "2 hours",
                            "template": "2 hours"
                        },
                        {
                            "text": ">2 hours",
                            "template": ">2 hours"
                        }
                    ]
                },
                {
                    "text": "organized sports",
                    "template": "organized sports",
                    "type": "plus-minus"
                },
                {
                    "text": "type of sports",
                    "template": "involved in",
                    "children": [
                        {
                            "text": "basketball",
                            "template": "basketball"
                        },
                        {
                            "text": "baseball",
                            "template": "baseball"
                        },
                        {
                            "text": "cheer\/dance\/drill",
                            "template": "cheer\/dance\/drill"
                        },
                        {
                            "text": "crosscountry",
                            "template": "crosscountry"
                        },
                        {
                            "text": "football",
                            "template": "football"
                        },
                        {
                            "text": "golf",
                            "template": "golf"
                        },
                        {
                            "text": "gymnastics",
                            "template": "gymnastics"
                        },
                        {
                            "text": "lacrosse",
                            "template": "lacrosse"
                        },
                        {
                            "text": "soccer",
                            "template": "soccer"
                        },
                        {
                            "text": "softball",
                            "template": "softball"
                        },
                        {
                            "text": "surfing",
                            "template": "surfing"
                        },
                        {
                            "text": "swimming",
                            "template": "swimming"
                        },
                        {
                            "text": "tennis",
                            "template": "tennis"
                        },
                        {
                            "text": "track",
                            "template": "track"
                        },
                        {
                            "text": "volleyball",
                            "template": "volleyball"
                        },
                        {
                            "text": "wrestling",
                            "template": "wrestling"
                        },
                        {
                            "text": "hockey",
                            "template": "hockey"
                        }
                    ]
                },
                {
                    "text": "organized groups\/clubs",
                    "template": "organized groups\/clubs",
                    "type": "plus-minus"
                },
                {
                    "text": "other activity\/social (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Immunizations",
            "template": "Immunizations: {children}.",
            "children": [
                {
                    "text": "up to date",
                    "template": "immunizations up to date"
                },
                {
                    "text": "see record for vaccine hx",
                    "template": "see immunization record for vaccine history"
                },
                {
                    "text": "not performed due to",
                    "template": "immunizations not performed due to",
                    "children": [
                        {
                            "text": "contrication",
                            "template": "contrication"
                        },
                        {
                            "text": "compromised condition",
                            "template": "compromised condition"
                        },
                        {
                            "text": "acute illness",
                            "template": "acute illness"
                        },
                        {
                            "text": "chronic illness",
                            "template": "chronic illness"
                        },
                        {
                            "text": "allergy of vaccine or component",
                            "template": "allergy of vaccine or component"
                        },
                        {
                            "text": "religious belief or group pressure",
                            "template": "religious belief or group pressure"
                        },
                        {
                            "text": "patient refusal",
                            "template": "patient refusal"
                        },
                        {
                            "text": "parent\/caregiver refusal",
                            "template": "parent\/caregiver refusal"
                        }
                    ]
                },
                {
                    "text": "other immunizations (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}