{
    "section": "subjective",
    "templateSet": "Asthma, pediatric",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "Patient presents for {children}.",
            "children": [
                {
                    "text": "new onset symptom evaluation",
                    "template": "evaluation of new onset symptoms"
                },
                {
                    "text": "initial evaluation of asthma symptoms",
                    "template": "initial evaluation of asthma symptoms"
                },
                {
                    "text": "follow-up asthma evaluation",
                    "template": "follow-up asthma evaluation"
                },
                {
                    "text": "ongoing asthma management",
                    "template": "ongoing asthma management"
                },
                {
                    "text": "Visit reason (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Asthma sx control",
            "template": "Asthma symptom control: {children}.",
            "children": [
                {
                    "text": "Overall sx course",
                    "template": "overall symptom course is {children}",
                    "children": [
                        {
                            "text": "stable",
                            "template": "stable"
                        },
                        {
                            "text": "improving",
                            "template": "improving"
                        },
                        {
                            "text": "worsening",
                            "template": "worsening"
                        },
                        {
                            "text": "intermittently controlled",
                            "template": "intermittently controlled"
                        },
                        {
                            "text": "uncontrolled",
                            "template": "uncontrolled"
                        },
                        {
                            "text": "acute exacerbation",
                            "template": "acute exacerbation"
                        },
                        {
                            "text": "uncomplicated exacerbation",
                            "template": "uncomplicated exacerbation"
                        },
                        {
                            "text": "status asthmaticus",
                            "template": "status asthmaticus"
                        },
                        {
                            "text": "recently improving after an exacerbation",
                            "template": "recently improving after an exacerbation"
                        }
                    ]
                },
                {
                    "text": "Sx: type",
                    "template": "symptom type is",
                    "children": [
                        {
                            "text": "cough varient",
                            "template": "cough varient"
                        },
                        {
                            "text": "childhood",
                            "template": "childhood"
                        },
                        {
                            "text": "exercised induced bronchospasm",
                            "template": "exercised induced bronchospasm"
                        },
                        {
                            "text": "extrinsic nonallergic",
                            "template": "extrinsic nonallergic"
                        },
                        {
                            "text": "idosyncratic",
                            "template": "idosyncratic"
                        },
                        {
                            "text": "intrinsic nonallergic",
                            "template": "intrinsic nonallergic"
                        },
                        {
                            "text": "late-onset",
                            "template": "late-onset"
                        },
                        {
                            "text": "mixed",
                            "template": "mixed"
                        }
                    ]
                },
                {
                    "text": "Sx: severity",
                    "template": "symptom severity is",
                    "children": [
                        {
                            "text": "mild intermittent",
                            "template": "mild intermittent"
                        },
                        {
                            "text": "mild persistent",
                            "template": "mild persistent"
                        },
                        {
                            "text": "moderate persistent",
                            "template": "moderate persistent"
                        },
                        {
                            "text": "severe persistent",
                            "template": "severe persistent"
                        }
                    ]
                },
                {
                    "text": "Sx: wheeze, cough, dyspnea",
                    "template": "symptoms include {children}",
                    "children": [
                        {
                            "text": "wheezing",
                            "template": "wheezing",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dyspnea",
                            "template": "dyspnea",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cough",
                            "template": "cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dyspnea w\/ vigorous activity",
                            "template": "dyspnea w\/ vigorous activity",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dyspnea on exertion",
                            "template": "dyspnea on exertion",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dyspnea w\/ minimal activity",
                            "template": "dyspnea w\/ minimal activity",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dyspnea at rest",
                            "template": "dyspnea at rest",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cough: dry",
                            "template": "dry cough"
                        },
                        {
                            "text": "cough: clear sputum",
                            "template": "cough productive of sputum"
                        },
                        {
                            "text": "cough: productive sputum",
                            "template": "cough productive of sputum"
                        },
                        {
                            "text": "cough: mucoid sputum",
                            "template": "cough productive of mucoid sputum"
                        }
                    ]
                },
                {
                    "text": "Sx: frequency",
                    "template": "symptom frequency: {children}",
                    "children": [
                        {
                            "text": "asymptomatic",
                            "template": "asymptomatic"
                        },
                        {
                            "text": "0-2 days\/week",
                            "template": "0-2 days per week"
                        },
                        {
                            "text": "2-6 days\/week",
                            "template": "2 to 6 days per week"
                        },
                        {
                            "text": "daily",
                            "template": "experienced daily"
                        },
                        {
                            "text": ">1x\/day",
                            "template": "experienced more than once a day"
                        }
                    ]
                },
                {
                    "text": "Nighttime awakening frequency",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no nighttime awakenings",
                            "template": "no nighttime awakenings"
                        },
                        {
                            "text": "0-2 times per month",
                            "template": "nighttime awakenings 2 or fewer times per month"
                        },
                        {
                            "text": "1-3 times per week",
                            "template": "nighttime awakenings 1-3 times per week"
                        },
                        {
                            "text": "4+ times per week",
                            "template": "nighttime awakenings 4 or more times per week"
                        }
                    ]
                },
                {
                    "text": "Interference w\/ activities",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no interference w\/ usual activities",
                            "template": "sx do not interfere with usual activities"
                        },
                        {
                            "text": "some limitation to usual activities",
                            "template": "sx cause some limitation to usual activities"
                        },
                        {
                            "text": "extreme limitation to usual activities",
                            "template": "sx cause extreme limitation to usual activities"
                        }
                    ]
                },
                {
                    "text": "Need for short-acting rescue inhaler",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no need for rescue beta-agonist",
                            "template": "no requirement for rescue beta-agonist"
                        },
                        {
                            "text": "0-2 days\/week beta-agonist rescue",
                            "template": "rescue beta-agonist required 0-2 times per week"
                        },
                        {
                            "text": "2+ days\/week beta-agonist rescue",
                            "template": "rescue beta-agonist required 2 or more times per week"
                        },
                        {
                            "text": "several times\/day beta-agonist rescue",
                            "template": "rescue beta-agonist required several times per day"
                        }
                    ]
                },
                {
                    "text": "Peak flow\/ PFT results",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "peak flow not measured",
                            "template": "peak flow not measured"
                        },
                        {
                            "text": "peak flow >80% personal best",
                            "template": "peak flow >80% personal best"
                        },
                        {
                            "text": "peak flow 60-80% personal best",
                            "template": "peak flow 60-80% personal best"
                        },
                        {
                            "text": "peak flow <60% personal best",
                            "template": "peak flow <60% personal best"
                        },
                        {
                            "text": "FEV1 >80% predicted",
                            "template": "FEV1 >80% predicted"
                        },
                        {
                            "text": "FEV1 60-80% predicted",
                            "template": "FEV1 60-80% predicted"
                        },
                        {
                            "text": "FEV1 <60% predicted",
                            "template": "FEV1 <60% predicted"
                        }
                    ]
                },
                {
                    "text": "Adherence to current tx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "not requiring drugs currently",
                            "template": "not requiring drugs currently"
                        },
                        {
                            "text": "adherent to current controller therapy",
                            "template": "adherent to current controller therapy"
                        },
                        {
                            "text": "partially adherent to controller therapy",
                            "template": "partially adherent to controller therapy"
                        },
                        {
                            "text": "intermittently adherent to controller therapy",
                            "template": "intermittently adherent to controller therapy"
                        },
                        {
                            "text": "not adherent to controller therapy",
                            "template": "not adherent to controller therapy"
                        }
                    ]
                },
                {
                    "text": "Exacerbations req oral steroids past yr (specify)",
                    "template": "number of exacerbations requiring oral steroids in previous year: {text}",
                    "type": "number"
                },
                {
                    "text": "Symptom control (describe)",
                    "template": "symptom control: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Triggers\/Relievers",
            "template": "Pt reports that {children}.",
            "children": [
                {
                    "text": "Worsened by exposures\/factors",
                    "template": "sx worsen with {children}",
                    "children": [
                        {
                            "text": "exercise",
                            "template": "exercise"
                        },
                        {
                            "text": "exercise (shortly after starting)",
                            "template": "exercise (shortly after starting)"
                        },
                        {
                            "text": "exercise (well into or after ending)",
                            "template": "exercise (well into or after ending)"
                        },
                        {
                            "text": "cough",
                            "template": "cough"
                        },
                        {
                            "text": "cold air",
                            "template": "cold air"
                        },
                        {
                            "text": "dry air",
                            "template": "dry air"
                        },
                        {
                            "text": "humidity",
                            "template": "humidity"
                        },
                        {
                            "text": "outdoors",
                            "template": "being outdoors"
                        },
                        {
                            "text": "indoors",
                            "template": "being indoors"
                        },
                        {
                            "text": "pollen",
                            "template": "exposure to pollen"
                        },
                        {
                            "text": "dust",
                            "template": "exposure to dust"
                        },
                        {
                            "text": "pet dander",
                            "template": "exposure to pet dander"
                        },
                        {
                            "text": "cockroach debris",
                            "template": "exposure to cockroach debris"
                        },
                        {
                            "text": "infections",
                            "template": "infections"
                        },
                        {
                            "text": "cigarette smoke",
                            "template": "exposure to cigarette smoke"
                        },
                        {
                            "text": "household chemicals",
                            "template": "exposure to household chemicals"
                        },
                        {
                            "text": "workplace chemicals",
                            "template": "exposure to workplace chemicals"
                        },
                        {
                            "text": "air pollution",
                            "template": "air pollution"
                        },
                        {
                            "text": "fumes",
                            "template": "exposure to fumes"
                        },
                        {
                            "text": "stress",
                            "template": "stress"
                        },
                        {
                            "text": "lying flat",
                            "template": "lying flat"
                        }
                    ]
                },
                {
                    "text": "Improved by exposures\/factors",
                    "template": "sx improve with {children}",
                    "children": [
                        {
                            "text": "sitting upright",
                            "template": "sitting upright"
                        },
                        {
                            "text": "rest",
                            "template": "rest"
                        },
                        {
                            "text": "indoors",
                            "template": "being indoors"
                        },
                        {
                            "text": "outdoors",
                            "template": "being outdoors"
                        },
                        {
                            "text": "humidity",
                            "template": "humidity"
                        },
                        {
                            "text": "steam",
                            "template": "steam"
                        },
                        {
                            "text": "warm environments",
                            "template": "warm environments"
                        },
                        {
                            "text": "cold air",
                            "template": "cold air"
                        },
                        {
                            "text": "dry air",
                            "template": "dry air"
                        }
                    ]
                },
                {
                    "text": "Worst times of day\/year",
                    "template": "sx are worse in {children}",
                    "children": [
                        {
                            "text": "morning",
                            "template": "morning"
                        },
                        {
                            "text": "afternoon",
                            "template": "afternoon"
                        },
                        {
                            "text": "evening",
                            "template": "evening"
                        },
                        {
                            "text": "night",
                            "template": "night"
                        },
                        {
                            "text": "springtime",
                            "template": "springtime"
                        },
                        {
                            "text": "summer",
                            "template": "summer"
                        },
                        {
                            "text": "autumn",
                            "template": "autumn"
                        },
                        {
                            "text": "winter",
                            "template": "winter"
                        }
                    ]
                },
                {
                    "text": "Best times of day\/year",
                    "template": "sx are best controlled during {children}",
                    "children": [
                        {
                            "text": "morning",
                            "template": "morning"
                        },
                        {
                            "text": "afternoon",
                            "template": "afternoon"
                        },
                        {
                            "text": "evening",
                            "template": "evening"
                        },
                        {
                            "text": "night",
                            "template": "night"
                        },
                        {
                            "text": "springtime",
                            "template": "springtime"
                        },
                        {
                            "text": "summer",
                            "template": "summer"
                        },
                        {
                            "text": "autumn",
                            "template": "autumn"
                        },
                        {
                            "text": "winter",
                            "template": "winter"
                        }
                    ]
                },
                {
                    "text": "Response to beta-agonist",
                    "template": "beta-agonist relief is {children}",
                    "children": [
                        {
                            "text": "immediate relief",
                            "template": "immediate"
                        },
                        {
                            "text": "delayed relief",
                            "template": "delayed"
                        },
                        {
                            "text": "partial relief",
                            "template": "partial"
                        },
                        {
                            "text": "inadequate relief",
                            "template": "inadequate"
                        },
                        {
                            "text": "adequate relief",
                            "template": "adequate"
                        }
                    ]
                },
                {
                    "text": "Other triggers\/relievers (specify)",
                    "template": "also reports {text} as factor(s)",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include: {children}.",
            "children": [
                {
                    "text": "shortness of breath",
                    "template": "shortness of breath",
                    "type": "plus-minus"
                },
                {
                    "text": "orthopnea",
                    "template": "orthopnea",
                    "type": "plus-minus"
                },
                {
                    "text": "choking sensation",
                    "template": "choking sensation",
                    "type": "plus-minus"
                },
                {
                    "text": "band-like chest constriction",
                    "template": "band-like chest constriction",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal congestion",
                    "template": "nasal congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "sneezing",
                    "template": "sneezing",
                    "type": "plus-minus"
                },
                {
                    "text": "rhinorrhea",
                    "template": "rhinorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "conjunctival sx",
                    "template": "conjunctival sx",
                    "type": "plus-minus"
                },
                {
                    "text": "chest wall pain",
                    "template": "chest wall pain",
                    "type": "plus-minus"
                },
                {
                    "text": "snoring",
                    "template": "snoring",
                    "type": "plus-minus"
                },
                {
                    "text": "reflux",
                    "template": "reflux",
                    "type": "plus-minus"
                },
                {
                    "text": "Infectious symptoms",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "exposure to ill patient",
                            "template": "exposure to ill patient",
                            "type": "plus-minus"
                        },
                        {
                            "text": "purulent sputum",
                            "template": "purulent sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "changed sputum",
                            "template": "changed sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dry cough",
                            "template": "dry cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "sore throat",
                            "template": "sore throat",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nasal discharge",
                            "template": "nasal discharge",
                            "type": "plus-minus"
                        },
                        {
                            "text": "fever",
                            "template": "fever",
                            "type": "plus-minus"
                        },
                        {
                            "text": "chills",
                            "template": "chills",
                            "type": "plus-minus"
                        },
                        {
                            "text": "myalgia",
                            "template": "myalgia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea",
                            "type": "plus-minus"
                        },
                        {
                            "text": "vomiting",
                            "template": "vomiting",
                            "type": "plus-minus"
                        },
                        {
                            "text": "diarrhea",
                            "template": "diarrhea",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "T max (degrees F)",
                    "template": "T max: {text} F.",
                    "type": "number"
                },
                {
                    "text": "other pertinent sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Tx response\/Side effects",
            "template": "Treatment effects: {children}.",
            "children": [
                {
                    "text": "adherent to current tx",
                    "template": "adherent to current tx"
                },
                {
                    "text": "nonadherent to current tx",
                    "template": "nonadherent to current tx"
                },
                {
                    "text": "Reasons for nonadherence",
                    "template": "reasons for nonadherence include {children}",
                    "children": [
                        {
                            "text": "side effects",
                            "template": "side effects"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea"
                        },
                        {
                            "text": "stomach upset",
                            "template": "stomach upset"
                        },
                        {
                            "text": "diarrhea",
                            "template": "diarrhea"
                        },
                        {
                            "text": "swallowing difficulty",
                            "template": "difficulty swallowing"
                        },
                        {
                            "text": "cost",
                            "template": "cost"
                        },
                        {
                            "text": "difficulty scheduling",
                            "template": "difficulty scheduling"
                        },
                        {
                            "text": "forgetfulness",
                            "template": "forgetfulness"
                        },
                        {
                            "text": "no perceived need for tx",
                            "template": "no perceived need for treatment"
                        }
                    ]
                },
                {
                    "text": "Nonadherence (describe)",
                    "template": "nonadherent to tx ({text})",
                    "type": "alpha"
                },
                {
                    "text": "Response to beta-agonist",
                    "template": "beta-agonist relief is {children}",
                    "children": [
                        {
                            "text": "immediate relief",
                            "template": "immediate"
                        },
                        {
                            "text": "delayed relief",
                            "template": "delayed"
                        },
                        {
                            "text": "partial relief",
                            "template": "partial"
                        },
                        {
                            "text": "inadequate relief",
                            "template": "inadequate"
                        },
                        {
                            "text": "adequate relief",
                            "template": "adequate"
                        }
                    ]
                },
                {
                    "text": "Treatment response",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "resolved with treatment",
                            "template": "resolved with treatment"
                        },
                        {
                            "text": "well-controlled on treatment",
                            "template": "well-controlled on treatment"
                        },
                        {
                            "text": "improving on treatment",
                            "template": "improving on treatment"
                        },
                        {
                            "text": "stable on treatment",
                            "template": "stable on treatment"
                        },
                        {
                            "text": "unchanged on treatment",
                            "template": "unchanged on treatment"
                        },
                        {
                            "text": "variable response to treatment",
                            "template": "variable response to treatment"
                        },
                        {
                            "text": "suboptimally-controlled on treatment",
                            "template": "suboptimally-controlled on treatment"
                        },
                        {
                            "text": "poorly-controlled on treatment",
                            "template": "poorly-controlled on treatment"
                        },
                        {
                            "text": "worsening on treatment",
                            "template": "worsening on treatment"
                        },
                        {
                            "text": "exacerbated despite treatment",
                            "template": "exacerbated despite treatment"
                        }
                    ]
                },
                {
                    "text": "Treatment response (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "no side effects noted",
                    "template": "no side effects noted"
                },
                {
                    "text": "Common side effects",
                    "template": "side effects include {children}",
                    "children": [
                        {
                            "text": "tremor",
                            "template": "tremor",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nervousness",
                            "template": "nervousness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "rapid heartbeat",
                            "template": "rapid heartbeat",
                            "type": "plus-minus"
                        },
                        {
                            "text": "palpitations",
                            "template": "palpitations",
                            "type": "plus-minus"
                        },
                        {
                            "text": "insomnia",
                            "template": "insomnia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dizziness\/vertigo",
                            "template": "dizziness\/vertigo",
                            "type": "plus-minus"
                        },
                        {
                            "text": "headache",
                            "template": "headache",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nasal congestion",
                            "template": "nasal congestion",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dry mouth",
                            "template": "dry mouth",
                            "type": "plus-minus"
                        },
                        {
                            "text": "taste changes",
                            "template": "taste changes",
                            "type": "plus-minus"
                        },
                        {
                            "text": "thrush",
                            "template": "thrush",
                            "type": "plus-minus"
                        },
                        {
                            "text": "throat irritation",
                            "template": "throat irritation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cough",
                            "template": "cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea\/vomiting",
                            "template": "nausea\/vomiting",
                            "type": "plus-minus"
                        },
                        {
                            "text": "GI upset",
                            "template": "GI upset",
                            "type": "plus-minus"
                        },
                        {
                            "text": "fluid retention",
                            "template": "fluid retention",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Side effects (describe)",
                    "template": "side effects: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Previous history includes {children}.",
            "children": [
                {
                    "text": "# Exac. req. oral steroids",
                    "template": "number of exacerbations requiring oral steroids in previous year: {text}",
                    "type": "number"
                },
                {
                    "text": "Hx exac requiring PO steroids",
                    "template": "Hx exacerbation requiring oral steroids",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx exac requiring urgent care\/ER",
                    "template": "Hx exacerbation requiring urgent care\/ER visit",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx exac requiring non-ICU inpt. stay",
                    "template": "Hx exacerbation requiring non-ICU inpatient stay",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx exac requiring ICU stay",
                    "template": "Hx exacerbation requiring ICU stay",
                    "type": "plus-minus"
                },
                {
                    "text": "asthma in youth",
                    "template": "asthma in youth",
                    "type": "plus-minus"
                },
                {
                    "text": "allergy\/hayfever",
                    "template": "allergy\/hayfever",
                    "type": "plus-minus"
                },
                {
                    "text": "aspirin sensitivity",
                    "template": "aspirin sensitivity",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal polyps",
                    "template": "nasal polyps",
                    "type": "plus-minus"
                },
                {
                    "text": "chronic bronchitis",
                    "template": "chronic bronchitis",
                    "type": "plus-minus"
                },
                {
                    "text": "COPD",
                    "template": "COPD",
                    "type": "plus-minus"
                },
                {
                    "text": "recent respiratory infection",
                    "template": "recent respiratory infection",
                    "type": "plus-minus"
                },
                {
                    "text": "current beta-blocker use",
                    "template": "current beta-blocker use",
                    "type": "plus-minus"
                },
                {
                    "text": "GE reflux",
                    "template": "GE reflux",
                    "type": "plus-minus"
                },
                {
                    "text": "sleep apnea",
                    "template": "sleep apnea",
                    "type": "plus-minus"
                },
                {
                    "text": "heart failure",
                    "template": "heart failure",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes mellitus",
                    "template": "diabetes mellitus",
                    "type": "plus-minus"
                },
                {
                    "text": "Immunodeficiency",
                    "template": "Hx {text}",
                    "type": "alpha"
                },
                {
                    "text": "Environment\/Occupation exposure:",
                    "template": "exposures: {text}",
                    "type": "alpha"
                },
                {
                    "text": "other medical Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Smoking status",
            "template": "Smoking status: {children}.",
            "children": [
                {
                    "text": "nonsmoker",
                    "template": "nonsmoker"
                },
                {
                    "text": "tobacco abuse",
                    "template": "tobacco abuse",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco dependence",
                    "template": "tobacco dependence",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco products used",
                    "template": "tobacco products used include {children}",
                    "children": [
                        {
                            "text": "cigarettes",
                            "template": "cigarettes"
                        },
                        {
                            "text": "cigars",
                            "template": "cigars"
                        },
                        {
                            "text": "pipes",
                            "template": "pipes"
                        },
                        {
                            "text": "water pipes",
                            "template": "water pipes"
                        },
                        {
                            "text": "chew",
                            "template": "chew"
                        },
                        {
                            "text": "snuff",
                            "template": "snuff"
                        }
                    ]
                },
                {
                    "text": "packs per day (specify)",
                    "template": "{text} packs per day",
                    "type": "number"
                },
                {
                    "text": "age at smoking onset (specify)",
                    "template": "started smoking at age {text}",
                    "type": "number"
                },
                {
                    "text": "smoking duration (months)",
                    "template": "smoking duration is {text} months",
                    "type": "number"
                },
                {
                    "text": "smoking duration (years)",
                    "template": "smoking duration is {text} years",
                    "type": "number"
                },
                {
                    "text": "tobacco withdrawal",
                    "template": "tobacco withdrawal",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco remission",
                    "template": "tobacco remission",
                    "type": "plus-minus"
                },
                {
                    "text": "hx of nicotine dependence (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "second hand smoke type\/exposure (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "other (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": "flu vaccine received this season",
                    "template": "flu vaccine received this season",
                    "type": "plus-minus"
                },
                {
                    "text": "pneumococcal vaccine Hx",
                    "template": "pneumococcal vaccine Hx",
                    "type": "plus-minus"
                },
                {
                    "text": "meningococcal vaccine Hx",
                    "template": "meningococcal vaccine Hx",
                    "type": "plus-minus"
                },
                {
                    "text": "Pertussis vaccine",
                    "template": "pertussis vaccine: {children}",
                    "children": [
                        {
                            "text": "up to date",
                            "template": "up to date"
                        },
                        {
                            "text": "not up to date",
                            "template": "not up to date"
                        }
                    ]
                },
                {
                    "text": "Diphtheria vaccine",
                    "template": "diphtheria vaccine: {children}",
                    "children": [
                        {
                            "text": "up to date",
                            "template": "up to date"
                        },
                        {
                            "text": "not up to date",
                            "template": "not up to date"
                        }
                    ]
                },
                {
                    "text": "other immunizations (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}