{
    "section": "subjective",
    "templateSet": "Pessary Care",
    "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 prolapse",
                    "template": "initial evaluation pelvic organ prolapse"
                },
                {
                    "text": "follow-up prolapse evaluation",
                    "template": "follow-up evaluation of pelvic organ prolapse"
                },
                {
                    "text": "ongoing prolapse management",
                    "template": "ongoing management of prolapse"
                },
                {
                    "text": "evaluation of pelvic pressure",
                    "template": "evaluation of pelvic pressure"
                },
                {
                    "text": "pessary care",
                    "template": "pessary care and follow up"
                },
                {
                    "text": "vaginal problems",
                    "template": "complaint involving {children}",
                    "children": [
                        {
                            "text": "vaginal discharge",
                            "template": "vaginal discharge"
                        },
                        {
                            "text": "bleeding per vagina",
                            "template": "bleeding per vagina"
                        }
                    ]
                },
                {
                    "text": "visit reason (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Onset\/Time course",
            "template": "Condition {children}.",
            "children": [
                {
                    "text": "acute onset (new condition)",
                    "template": "is reported to have developed acutely"
                },
                {
                    "text": "chronic and ongoing condition",
                    "template": "is chronic and ongoing"
                },
                {
                    "text": "acutely worse (chronic condition)",
                    "template": "severity is reported to have acutely worsened"
                },
                {
                    "text": "progressive worsened",
                    "template": "is reported to have progressively worsened"
                },
                {
                    "text": "intermittent presence of symptoms",
                    "template": "symptoms are described as intermittently present"
                },
                {
                    "text": "Duration (hours)",
                    "template": "is reported as having been present for {text} hours",
                    "type": "number"
                },
                {
                    "text": "Duration (days)",
                    "template": "is reported as having been present for {text} days",
                    "type": "number"
                },
                {
                    "text": "Duration (weeks)",
                    "template": "is reported as having been present for {text} weeks",
                    "type": "number"
                },
                {
                    "text": "Duration (months)",
                    "template": "is reported as having been present for {text} months",
                    "type": "number"
                },
                {
                    "text": "Duration (years)",
                    "template": "is reported as having been present for {text} years",
                    "type": "number"
                },
                {
                    "text": "Duration (describe)",
                    "template": "is reported as having been present for {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Symptoms\/Functional impact",
            "template": "Patient reports the presence\/absence of the following hx\/sx related to the current\n                        visit: {children}.\n                    ",
            "children": [
                {
                    "text": "no complaints",
                    "template": "Patient has no complaints."
                },
                {
                    "text": "frequent need to urinate",
                    "template": "need to urinate occurs {children}",
                    "children": [
                        {
                            "text": "approximately every 3 to 4 hours",
                            "template": "approximately every 3 to 4 hours"
                        },
                        {
                            "text": "approximately every two hours",
                            "template": "approximately every two hours"
                        },
                        {
                            "text": "about every hour",
                            "template": "about every hour"
                        },
                        {
                            "text": "multiple times in an hour",
                            "template": "multiple times in an hour"
                        },
                        {
                            "text": "only after going to bed",
                            "template": "only after going to bed"
                        }
                    ]
                },
                {
                    "text": "nocturia",
                    "template": "nocturia occurs {text} times per night",
                    "type": "number"
                },
                {
                    "text": "incomplete bladder emptying",
                    "template": "incomplete bladder emptying",
                    "type": "plus-minus"
                },
                {
                    "text": "difficulty initiating urine stream",
                    "template": "difficulty initiating urine stream",
                    "type": "plus-minus"
                },
                {
                    "text": "functional impact",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no limitation of physical activity",
                            "template": "no limitation of physical activity"
                        },
                        {
                            "text": "slight limitation of physical activity",
                            "template": "slight limitation of physical activity"
                        },
                        {
                            "text": "marked limitation of physical activity",
                            "template": "marked limitation of physical activity"
                        },
                        {
                            "text": "unable to carry out any activity",
                            "template": "unable to carry out any activity without discomfort"
                        },
                        {
                            "text": "condition limits social activities",
                            "template": "condition limits social activities"
                        },
                        {
                            "text": "condition does not limit social activities",
                            "template": "condition does not limit social activities"
                        }
                    ]
                },
                {
                    "text": "needing to splint to evacuate bowel",
                    "template": "needing to splint to evacuate her bowel using {children}",
                    "children": [
                        {
                            "text": "digital pressure on the vagina",
                            "template": "digital pressure on the vagina"
                        },
                        {
                            "text": "digital pressure on the perineum",
                            "template": "digital pressure on the perineum"
                        },
                        {
                            "text": "change in positioning",
                            "template": "change in positioning"
                        }
                    ]
                },
                {
                    "text": "requiring maneuvers to evacuate the bladder",
                    "template": "requiring maneuvers to evacuate the bladder including {children}",
                    "children": [
                        {
                            "text": "pushing the bladder back inside digitally",
                            "template": "pushing the bladder back inside digitally"
                        },
                        {
                            "text": "changing positions to assist with emptying",
                            "template": "changing positions to assist with emptying"
                        },
                        {
                            "text": "multiple visits to the toilet daily",
                            "template": "multiple visits to the toilet daily"
                        },
                        {
                            "text": "bearing down",
                            "template": "bearing down"
                        }
                    ]
                },
                {
                    "text": "difficulty with intercourse",
                    "template": "difficulty with intercourse"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "bleeding per vagina",
                    "template": "bleeding per vagina",
                    "type": "plus-minus"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "distension: abdominal",
                    "template": "abdominal distension",
                    "type": "plus-minus"
                },
                {
                    "text": "dysuria",
                    "template": "dysuria",
                    "type": "plus-minus"
                },
                {
                    "text": "fecal incontinence",
                    "template": "fecal incontinence",
                    "type": "plus-minus"
                },
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "hematuria",
                    "template": "hematuria",
                    "type": "plus-minus"
                },
                {
                    "text": "lower extremity",
                    "template": "lower extremity",
                    "children": [
                        {
                            "text": "numbness",
                            "template": "numbness"
                        },
                        {
                            "text": "paresthesias",
                            "template": "paresthesias"
                        },
                        {
                            "text": "weakness",
                            "template": "weakness"
                        }
                    ]
                },
                {
                    "text": "nausea",
                    "template": "nausea",
                    "type": "plus-minus"
                },
                {
                    "text": "pain",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "pelvic pain",
                            "template": "pelvic pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "back pain",
                            "template": "back pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "flank pain",
                            "template": "flank pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "suprapubic pain",
                            "template": "suprapubic pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "perineal pain",
                            "template": "perineal pain",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "perianal sensation: decreased",
                    "template": "decreased perianal sensation",
                    "type": "plus-minus"
                },
                {
                    "text": "sneeze",
                    "template": "sneeze",
                    "type": "plus-minus"
                },
                {
                    "text": "urine",
                    "template": "{children} urine",
                    "children": [
                        {
                            "text": "cloudy",
                            "template": "cloudy"
                        },
                        {
                            "text": "foul smelling",
                            "template": "foul smelling"
                        }
                    ]
                },
                {
                    "text": "urinary dribbling",
                    "template": "urinary dribbling",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary frequency",
                    "template": "urinary frequency",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary incontinence",
                    "template": "urinary incontinence",
                    "type": "plus-minus"
                },
                {
                    "text": "other pertinent sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Exacerbating\/Alleviating factors",
            "template": "Patient reports that {children}.",
            "children": [
                {
                    "text": "weight gain",
                    "template": "weight gain {children}",
                    "children": [
                        {
                            "text": "worsens sx",
                            "template": "has worsened sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has had no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "coughing",
                    "template": "coughing {children}",
                    "children": [
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "sneezing",
                    "template": "sneezing {children}",
                    "children": [
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "exercise",
                    "template": "exercise",
                    "children": [
                        {
                            "text": "worsens symptoms",
                            "template": "worsens symptoms"
                        },
                        {
                            "text": "has no impact on symptoms",
                            "template": "has no impact on symptoms"
                        },
                        {
                            "text": "improves symptoms",
                            "template": "improves symptoms"
                        }
                    ]
                },
                {
                    "text": "kegel exercises",
                    "template": "kegel exercises {children}",
                    "children": [
                        {
                            "text": "improve sx",
                            "template": "improve sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been tried",
                            "template": "have not been tried"
                        }
                    ]
                },
                {
                    "text": "antispasmodic medications",
                    "template": "antispasmodic medications {children}",
                    "children": [
                        {
                            "text": "improve sx",
                            "template": "improve sx"
                        },
                        {
                            "text": "worsen sx",
                            "template": "worsen sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been tried",
                            "template": "have not been tried"
                        }
                    ]
                },
                {
                    "text": "lifting",
                    "template": "lifting {children}",
                    "children": [
                        {
                            "text": "worsens symptoms",
                            "template": "worsens symptoms"
                        },
                        {
                            "text": "has no effect on symptoms",
                            "template": "has no effect on symptoms"
                        }
                    ]
                },
                {
                    "text": "straining",
                    "template": "straining {children}",
                    "children": [
                        {
                            "text": "worsens symptoms",
                            "template": "worsens symptoms"
                        },
                        {
                            "text": "has no effect on symptoms",
                            "template": "has no effect on symptoms"
                        }
                    ]
                },
                {
                    "text": "no exacerbating or ameliorating factors",
                    "template": "no exacerbating or ameliorating factors are noted"
                },
                {
                    "text": "other contributing factors (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Previous treatments",
            "template": "Treatment effects: {children}.",
            "children": [
                {
                    "text": "no treatments have been given or prescribed",
                    "template": "no treatments have been given or prescribed for this problem"
                },
                {
                    "text": "adherent to current tx",
                    "template": "adherent to current tx"
                },
                {
                    "text": "treatment response",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no previous tx",
                            "template": "there have been no previous treatments"
                        },
                        {
                            "text": "resolved with tx",
                            "template": "resolved with treatment"
                        },
                        {
                            "text": "pessary use successful in ameliorating sx",
                            "template": "pessary use has been successful in ameliorating symptoms"
                        },
                        {
                            "text": "pessary use has helped somewhat with sx",
                            "template": "pessary use has helped somewhat with symptoms"
                        },
                        {
                            "text": "pessary use not been successful treating sx",
                            "template": "pessary use has not been successful in treating the symptoms"
                        },
                        {
                            "text": "surgical repair prolapse, partial improvement",
                            "template": "surgical repair of prolapse has resulted in partial improvement"
                        },
                        {
                            "text": "surgical tx has resulted in resolution of sx",
                            "template": "surgical treatment has resulted in resolution of symptoms"
                        },
                        {
                            "text": "recurrent prolapse after surgical repair",
                            "template": "recurrent prolapse after surgical repair"
                        },
                        {
                            "text": "pessary use helps but the pessary falls out",
                            "template": "pessary use helps but the pessary falls out"
                        },
                        {
                            "text": "pt is managing her own pessary",
                            "template": "patient is managing her own pessary"
                        }
                    ]
                },
                {
                    "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": "constipation",
                            "template": "constipation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dry eyes",
                            "template": "dry eyes",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea\/vomiting",
                            "template": "nausea\/vomiting",
                            "type": "plus-minus"
                        },
                        {
                            "text": "edema",
                            "template": "edema",
                            "type": "plus-minus"
                        },
                        {
                            "text": "difficulty urinating",
                            "template": "difficulty urinating"
                        },
                        {
                            "text": "vaginal discharge",
                            "template": "vaginal discharge"
                        },
                        {
                            "text": "bleeding per vagina",
                            "template": "bleeding per vagina"
                        }
                    ]
                },
                {
                    "text": "side effects (describe)",
                    "template": "side effects: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "back injury",
                    "template": "back injury",
                    "type": "plus-minus"
                },
                {
                    "text": "detrusor instability",
                    "template": "detrusor instability",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes type 1",
                    "template": "diabetes type 1",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes type 2",
                    "template": "diabetes type 2",
                    "type": "plus-minus"
                },
                {
                    "text": "immunosuppression",
                    "template": "immunosuppression",
                    "type": "plus-minus"
                },
                {
                    "text": "indwelling urinary catheter",
                    "template": "indwelling urinary catheter",
                    "type": "plus-minus"
                },
                {
                    "text": "pyelonephritis",
                    "template": "pyelonephritis",
                    "type": "plus-minus"
                },
                {
                    "text": "multiple sclerosis",
                    "template": "multiple sclerosis",
                    "type": "plus-minus"
                },
                {
                    "text": "nephrolithiasis",
                    "template": "nephrolithiasis",
                    "type": "plus-minus"
                },
                {
                    "text": "recurrent UTI",
                    "template": "recurrent UTI",
                    "type": "plus-minus"
                },
                {
                    "text": "renal insufficiency",
                    "template": "renal insufficiency",
                    "type": "plus-minus"
                },
                {
                    "text": "hx STD",
                    "template": "hx STD",
                    "type": "plus-minus"
                },
                {
                    "text": "history of pelvic irradiation",
                    "template": "history of pelvic irradiation",
                    "type": "plus-minus"
                },
                {
                    "text": "hx pelvic surgery",
                    "template": "history of pelvic surgery includes {children}",
                    "children": [
                        {
                            "text": "hysterectomy",
                            "template": "hysterectomy"
                        },
                        {
                            "text": "incontinence surgery",
                            "template": "previous incontinence surgery"
                        },
                        {
                            "text": "prolapse surgery performed vaginally",
                            "template": "previous prolapse surgery performed vaginally"
                        },
                        {
                            "text": "abdominal prolapse repair",
                            "template": "abdominal prolapse repair"
                        },
                        {
                            "text": "radical pelvic surgery for cancer",
                            "template": "previous radical pelvic surgery for cancer"
                        },
                        {
                            "text": "prolapse repair included insertion of mesh",
                            "template": "prolapse repair included insertion of mesh"
                        }
                    ]
                },
                {
                    "text": "overweight\/obesity",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "overweight",
                            "template": "overweight",
                            "type": "plus-minus"
                        },
                        {
                            "text": "obese",
                            "template": "obese",
                            "type": "plus-minus"
                        },
                        {
                            "text": "morbid obesity",
                            "template": "morbid obesity",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "obesity contributing factors (describe)",
                    "template": "obesity contributing factors {text}",
                    "type": "alpha"
                },
                {
                    "text": "other medical Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "OB\/Gyn Hx specific to visit",
            "template": "OB\/Gyn history includes {children}.",
            "children": [
                {
                    "text": "LMP (specify)",
                    "template": "LMP: {text}",
                    "type": "date"
                },
                {
                    "text": "pregnant",
                    "template": "pregnant",
                    "type": "plus-minus"
                },
                {
                    "text": "pregnancy history",
                    "template": "pregnancy history",
                    "type": "plus-minus"
                },
                {
                    "text": "vaginal delivery history",
                    "template": "vaginal delivery history",
                    "type": "plus-minus"
                },
                {
                    "text": "forceps delivery history",
                    "template": "forceps delivery history",
                    "type": "plus-minus"
                },
                {
                    "text": "pertinent delivery history",
                    "template": "pertinent delivery history",
                    "children": [
                        {
                            "text": "significant vaginal trauma w\/ delivery",
                            "template": "significant vaginal trauma with delivery",
                            "type": "plus-minus"
                        },
                        {
                            "text": "3rd\/4th degree laceration w\/ delivery",
                            "template": "3rd or 4th degree laceration with delivery",
                            "type": "plus-minus"
                        },
                        {
                            "text": "history of large babies",
                            "template": "history of large babies",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "other OB\/Gyn hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environment factors",
            "template": "Lifestyle\/Environment factors include {children}.",
            "children": [
                {
                    "text": "alcohol use",
                    "template": "alcohol use reported: {children}",
                    "children": [
                        {
                            "text": "none",
                            "template": "none"
                        },
                        {
                            "text": "social",
                            "template": "social"
                        },
                        {
                            "text": "1 drink per day",
                            "template": "1 drink per day"
                        },
                        {
                            "text": "2 drinks per day",
                            "template": "2 drinks per day"
                        },
                        {
                            "text": "more than 2 drinks per day",
                            "template": "more than 2 drinks per day"
                        },
                        {
                            "text": "binge drinking",
                            "template": "binge drinking"
                        }
                    ]
                },
                {
                    "text": "caffeine use",
                    "template": "caffeine use reported: {children}",
                    "children": [
                        {
                            "text": "coffee 1 cup\/day",
                            "template": "coffee 1 cup\/day"
                        },
                        {
                            "text": "coffee more than 2 cups per day",
                            "template": "coffee more than 2 cups per day"
                        },
                        {
                            "text": "caffeinated beverages 1 or more\/day",
                            "template": "caffeinated beverages 1 or more per day",
                            "type": "plus-minus"
                        },
                        {
                            "text": "tea (iced or hot) 1 or more per day",
                            "template": "tea (iced or hot) 1 or more per day",
                            "type": "plus-minus"
                        },
                        {
                            "text": "carbonated beverages",
                            "template": "carbonated beverages",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "cocaine use",
                    "template": "cocaine use",
                    "type": "plus-minus"
                },
                {
                    "text": "methamphetamine use",
                    "template": "methamphetamine use",
                    "type": "plus-minus"
                },
                {
                    "text": "high fat diet",
                    "template": "high fat diet",
                    "type": "plus-minus"
                },
                {
                    "text": "regular exercise",
                    "template": "regular exercise",
                    "type": "plus-minus"
                },
                {
                    "text": "nursing home resident",
                    "template": "nursing home resident",
                    "type": "plus-minus"
                },
                {
                    "text": "other lifestyle\/exposure (specify)",
                    "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"
                }
            ]
        }
    ]
}