{
    "section": "subjective",
    "templateSet": "Well Visit, Adult, Female",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "Patient presents for well-visit. {children}.",
            "children": [
                {
                    "text": "well-visit, no acute concerns",
                    "template": "Patient has no acute concerns"
                },
                {
                    "text": "Concerns include (specify)",
                    "template": "Patient's concerns include {text}.",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "History",
            "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": "sleep disturbance",
                    "template": "sleep disturbance",
                    "type": "plus-minus"
                },
                {
                    "text": "fatigue",
                    "template": "fatigue",
                    "type": "plus-minus"
                },
                {
                    "text": "change in weight",
                    "template": "change in weight",
                    "type": "plus-minus"
                },
                {
                    "text": "change in vision",
                    "template": "change in vision",
                    "type": "plus-minus"
                },
                {
                    "text": "change in hearing",
                    "template": "change in hearing",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "chest pain",
                    "template": "chest pain",
                    "type": "plus-minus"
                },
                {
                    "text": "shortness of breath",
                    "template": "shortness of breath",
                    "type": "plus-minus"
                },
                {
                    "text": "heartburn",
                    "template": "heartburn",
                    "type": "plus-minus"
                },
                {
                    "text": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "breast lump",
                    "template": "breast lump",
                    "type": "plus-minus"
                },
                {
                    "text": "abnormal menses",
                    "template": "abnormal menses",
                    "type": "plus-minus"
                },
                {
                    "text": "pain with intercourse",
                    "template": "pain with intercourse",
                    "type": "plus-minus"
                },
                {
                    "text": "joint pain",
                    "template": "joint pain",
                    "type": "plus-minus"
                },
                {
                    "text": "depression",
                    "template": "depression",
                    "type": "plus-minus"
                },
                {
                    "text": "moles",
                    "template": "moles",
                    "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": "lightheadedness",
                    "template": "lightheadedness",
                    "type": "plus-minus"
                },
                {
                    "text": "dizziness",
                    "template": "dizziness",
                    "type": "plus-minus"
                },
                {
                    "text": "decreased exercise tolerance",
                    "template": "decreased exercise tolerance",
                    "type": "plus-minus"
                },
                {
                    "text": "abdominal pain",
                    "template": "abdominal pain",
                    "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": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "change in stool firmness",
                    "template": "change in stool firmness",
                    "type": "plus-minus"
                },
                {
                    "text": "change in stool color",
                    "template": "change in stool color",
                    "type": "plus-minus"
                },
                {
                    "text": "change in stool size",
                    "template": "change in stool size",
                    "type": "plus-minus"
                },
                {
                    "text": "enlarging breast lump\/mass",
                    "template": "enlarging breast lump\/mass",
                    "type": "plus-minus"
                },
                {
                    "text": "bleeding between menstrual periods",
                    "template": "bleeding between menstrual periods",
                    "type": "plus-minus"
                },
                {
                    "text": "excessive pain with menses",
                    "template": "excessive pain with menses",
                    "type": "plus-minus"
                },
                {
                    "text": "loss of interest in sex",
                    "template": "loss of interest in sex",
                    "type": "plus-minus"
                },
                {
                    "text": "loss of sexual pleasure",
                    "template": "loss of sexual pleasure",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary incontinence",
                    "template": "urinary incontinence",
                    "type": "plus-minus"
                },
                {
                    "text": "nocturia",
                    "template": "nocturia",
                    "type": "plus-minus"
                },
                {
                    "text": "back pain",
                    "template": "back pain",
                    "type": "plus-minus"
                },
                {
                    "text": "lower extremity edema",
                    "template": "lower extremity edema",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "paresthesias",
                    "template": "paresthesias",
                    "type": "plus-minus"
                },
                {
                    "text": "focal extremity weakness",
                    "template": "focal extremity weakness",
                    "type": "plus-minus"
                },
                {
                    "text": "focal extremity numbness",
                    "template": "focal extremity numbness",
                    "type": "plus-minus"
                },
                {
                    "text": "depression",
                    "template": "depression",
                    "type": "plus-minus"
                },
                {
                    "text": "anxiety",
                    "template": "anxiety",
                    "type": "plus-minus"
                },
                {
                    "text": "loss of pleasure in usual activities",
                    "template": "loss of pleasure in usual activities",
                    "type": "plus-minus"
                },
                {
                    "text": "feeling hopeless",
                    "template": "feeling hopeless",
                    "type": "plus-minus"
                },
                {
                    "text": "Other pertinent sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "coronary artery disease",
                    "template": "coronary artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "symptomatic carotid artery disease",
                    "template": "symptomatic carotid artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "peripheral artery disease",
                    "template": "peripheral artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "abdominal aortic aneurysm",
                    "template": "abdominal aortic aneurysm",
                    "type": "plus-minus"
                },
                {
                    "text": "migraines",
                    "template": "migraines",
                    "type": "plus-minus"
                },
                {
                    "text": "DVT",
                    "template": "DVT",
                    "type": "plus-minus"
                },
                {
                    "text": "hyperlipidemia",
                    "template": "hyperlipidemia",
                    "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": "hypothyroidism",
                    "template": "hypothyroidism",
                    "type": "plus-minus"
                },
                {
                    "text": "kidney disease",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "CKD stage 1",
                            "template": "CKD stage 1",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 2 (mild)",
                            "template": "CKD stage 2 (mild)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 3 (moderate)",
                            "template": "CKD stage 3 (moderate)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 4 (severe)",
                            "template": "CKD stage 4 (severe)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "ESRD",
                            "template": "End Stage Renal Disease",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "liver disease",
                    "template": "liver disease",
                    "type": "plus-minus"
                },
                {
                    "text": "HPV infection",
                    "template": "HPV infection",
                    "type": "plus-minus"
                },
                {
                    "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": "Cancer history (describe)",
                    "template": "(+) cancer, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Abdominal surgery (describe)",
                    "template": "(+) abdominal surgery, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Other medical Hx (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "OB\/Gyn Hx specific to visit",
            "template": "OB\/Gyn Hx: {children}",
            "children": [
                {
                    "text": "LMP (specify)",
                    "template": "LMP: {text}",
                    "type": "date"
                },
                {
                    "text": "STD",
                    "template": "STD",
                    "type": "plus-minus"
                },
                {
                    "text": "using birth control",
                    "template": "using birth control",
                    "type": "plus-minus"
                },
                {
                    "text": "problems with birth control",
                    "template": "problems with birth control",
                    "type": "plus-minus"
                },
                {
                    "text": "Birth control type (specify)",
                    "template": "type of birth control: {text}",
                    "type": "alpha"
                },
                {
                    "text": "sexually active",
                    "template": "sexually active",
                    "type": "plus-minus"
                },
                {
                    "text": "Sexually active: Men\/women\/both",
                    "template": "(+) sexually active with {text}",
                    "type": "alpha"
                },
                {
                    "text": "Abnormal Pap smear (describe)",
                    "template": "(+) abnormal Pap smear, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Colposcopy (describe)",
                    "template": "(+) colposcopy, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Cervical biopsy (describe)",
                    "template": "(+) cervical biopsy, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Cervical surgery (describe)",
                    "template": "(+) cervical surgery, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Abnormal mammogram",
                    "template": "(+) abnormal mammogram, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Breast biopsy (describe)",
                    "template": "(+) breast biopsy, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Breast cyst drainage (describe)",
                    "template": "(+) breast cyst drainage, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Breast surgery (describe)",
                    "template": "(+) breast surgery, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Pelvic surgery (describe)",
                    "template": "(+) pelvic surgery, {text}",
                    "type": "alpha"
                },
                {
                    "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",
                    "type": "plus-minus"
                },
                {
                    "text": "Alcohol use (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "high-fat diet",
                    "template": "high-fat diet",
                    "type": "plus-minus"
                },
                {
                    "text": "regular exercise",
                    "template": "regular exercise",
                    "type": "plus-minus"
                },
                {
                    "text": "dental exam (past 6 months)",
                    "template": "dental exam (past 6 months)",
                    "type": "plus-minus"
                },
                {
                    "text": "regular seatbelt use",
                    "template": "regular seatbelt use",
                    "type": "plus-minus"
                },
                {
                    "text": "smoke detectors in home",
                    "template": "smoke detectors in home",
                    "type": "plus-minus"
                },
                {
                    "text": "firearms in home",
                    "template": "firearms in home",
                    "type": "plus-minus"
                },
                {
                    "text": "HPV immunization",
                    "template": "HPV immunization",
                    "type": "plus-minus"
                },
                {
                    "text": "sexually active",
                    "template": "sexually active",
                    "type": "plus-minus"
                },
                {
                    "text": "safe sex practices",
                    "template": "safe sex practices",
                    "type": "plus-minus"
                },
                {
                    "text": "Number of partners, lifetime",
                    "template": "Number of partners, lifetime: {text}",
                    "type": "number"
                },
                {
                    "text": "abuse",
                    "template": "abuse",
                    "type": "plus-minus"
                },
                {
                    "text": "Abuse concerns (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "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"
                }
            ]
        },
        {
            "text": "Family Hx specific to visit",
            "template": "Family history includes {children}.",
            "children": [
                {
                    "text": "cardiovascular disease",
                    "template": "cardiovascular disease",
                    "type": "plus-minus"
                },
                {
                    "text": "premature CAD, male relative",
                    "template": "MI and\/or sudden death in father\/male relative at <55 yo",
                    "type": "plus-minus"
                },
                {
                    "text": "premature CAD, female relative",
                    "template": "MI and\/or sudden death in mother\/female relative at <65 yo",
                    "type": "plus-minus"
                },
                {
                    "text": "stroke",
                    "template": "stroke",
                    "type": "plus-minus"
                },
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "hypercholesterolemia",
                    "template": "hypercholesterolemia",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes",
                    "template": "diabetes",
                    "type": "plus-minus"
                },
                {
                    "text": "osteoporosis",
                    "template": "osteoporosis",
                    "type": "plus-minus"
                },
                {
                    "text": "breast cancer",
                    "template": "breast cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "ovarian cancer",
                    "template": "ovarian cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "intestinal cancer",
                    "template": "intestinal cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "breast cancer (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                },
                {
                    "text": "ovarian cancer (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                },
                {
                    "text": "intestinal cancer (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                },
                {
                    "text": "Other family Hx (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}