{
    "section": "plan",
    "templateSet": "Urinary Incontinence, Male",
    "templates": [
        {
            "text": "Labs",
            "template": "{children}",
            "children": [
                {
                    "text": "Labs",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "CBC",
                            "template": "CBC"
                        },
                        {
                            "text": "Metabolic panel, basic (BMP), serum",
                            "template": "Metabolic panel, basic (BMP), serum"
                        },
                        {
                            "text": "Metabolic panel, comprehensive (CMP), serum",
                            "template": "Metabolic panel, comprehensive (CMP), serum"
                        },
                        {
                            "text": "Culture, urine, bacterial",
                            "template": "Culture, urine, bacterial"
                        },
                        {
                            "text": "Urine dipstick for nitrites and leukocyte esterase",
                            "template": "Urine dipstick for nitrites and leukocyte esterase"
                        },
                        {
                            "text": "Urinalysis, complete (with micro)",
                            "template": "Urinalysis, complete (with micro)"
                        },
                        {
                            "text": "PSA (prostate-specific antigen), serum",
                            "template": "PSA (prostate-specific antigen), serum"
                        },
                        {
                            "text": "Hemoglobin A1c (HbA1c), blood",
                            "template": "Hemoglobin A1c (HbA1c), blood"
                        },
                        {
                            "text": "Glucose, fingerstick",
                            "template": "Glucose, fingerstick"
                        },
                        {
                            "text": "Glucose, fasting, plasma",
                            "template": "Glucose, fasting, plasma"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Imaging",
            "template": "{children}",
            "children": [
                {
                    "text": "Imaging",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "X-ray abdomen (KUB)",
                            "template": "X-ray abdomen (KUB)"
                        },
                        {
                            "text": "CT abdomen and pelvis w\/ contrast",
                            "template": "CT abdomen and pelvis w\/ contrast"
                        },
                        {
                            "text": "CT abdomen and pelvis w\/o contrast",
                            "template": "CT abdomen and pelvis w\/o contrast"
                        },
                        {
                            "text": "US bladder",
                            "template": "US bladder"
                        },
                        {
                            "text": "US urethra",
                            "template": "US urethra"
                        },
                        {
                            "text": "US renal",
                            "template": "US renal"
                        },
                        {
                            "text": "MRI pelvis w\/ contrast",
                            "template": "MRI pelvis w\/ contrast"
                        },
                        {
                            "text": "MRI pelvis w\/o contrast",
                            "template": "MRI pelvis w\/o contrast"
                        },
                        {
                            "text": "Intravenous pyelogram (IVP)",
                            "template": "Intravenous pyelogram (IVP)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Procedures",
            "template": "{children}",
            "children": [
                {
                    "text": "Procedures",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Post-void residual by ultrasound",
                            "template": "Post-void residual by ultrasound"
                        },
                        {
                            "text": "Post-void residual by catheter",
                            "template": "Post-void residual by catheter"
                        },
                        {
                            "text": "Urodynamic testing",
                            "template": "Urodynamic testing"
                        },
                        {
                            "text": "Cystoscopy",
                            "template": "Cystoscopy"
                        },
                        {
                            "text": "Urethroscopy",
                            "template": "Urethroscopy"
                        },
                        {
                            "text": "Refer to Urology for periurethral collagen injection",
                            "template": "Refer to Urology for periurethral collagen injection"
                        },
                        {
                            "text": "Refer to Urology for intravesical botulinum toxin injection",
                            "template": "Refer to Urology for intravesical botulinum toxin injection"
                        },
                        {
                            "text": "EMG",
                            "template": "EMG"
                        },
                        {
                            "text": "Foley catheter placement",
                            "template": "Foley catheter placement"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Medications",
            "template": "{children}",
            "children": [
                {
                    "text": "Alpha-1 blockers",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "doxazosin 1 mg tab",
                            "template": "doxazosin 1 mg tab"
                        },
                        {
                            "text": "doxazosin 4 mg tab",
                            "template": "doxazosin 4 mg tab"
                        },
                        {
                            "text": "prazosin 1 mg cap",
                            "template": "prazosin 1 mg cap"
                        },
                        {
                            "text": "tamsulosin 0.4 mg cap",
                            "template": "tamsulosin 0.4 mg cap"
                        },
                        {
                            "text": "terazosin 1 mg cap",
                            "template": "terazosin 1 mg cap"
                        },
                        {
                            "text": "terazosin 10 mg cap",
                            "template": "terazosin 10 mg cap"
                        },
                        {
                            "text": "Rapaflo 8 mg cap",
                            "template": "Rapaflo 8 mg cap"
                        },
                        {
                            "text": "Uroxatral 10 mg ER tab",
                            "template": "Uroxatral 10 mg ER tab"
                        }
                    ]
                },
                {
                    "text": "5-alpha reductase inhibitors",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "finasteride 5 mg tab",
                            "template": "finasteride 5 mg tab"
                        },
                        {
                            "text": "Avodart 0.5 mg cap",
                            "template": "Avodart 0.5 mg cap"
                        }
                    ]
                },
                {
                    "text": "Combination alpha-1 blockers\/alpha reductase inhibitors",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Jalyn 0.5 mg\/0.4 mg cap",
                            "template": "Jalyn 0.5 mg\/0.4 mg cap"
                        }
                    ]
                },
                {
                    "text": "Antispasmodics",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "oxybutynin 5 mg tab",
                            "template": "oxybutynin 5 mg tab"
                        },
                        {
                            "text": "oxybutynin 5 mg ER tab",
                            "template": "oxybutynin 5 mg ER tab"
                        },
                        {
                            "text": "Detrol 2 mg tab",
                            "template": "Detrol 2 mg tab"
                        },
                        {
                            "text": "Detrol LA 4 mg ER cap",
                            "template": "Detrol LA 4 mg ER cap"
                        },
                        {
                            "text": "Toviaz 4 mg ER tab",
                            "template": "Toviaz 4 mg ER tab"
                        },
                        {
                            "text": "Vesicare 5 mg tab",
                            "template": "Vesicare 5 mg tab"
                        }
                    ]
                },
                {
                    "text": "Tricyclics",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "amitriptyline 25 mg tab",
                            "template": "amitriptyline 25 mg tab"
                        },
                        {
                            "text": "desipramine 25 mg tab",
                            "template": "desipramine 25 mg tab"
                        },
                        {
                            "text": "doxepin 25 mg cap",
                            "template": "doxepin 25 mg cap"
                        },
                        {
                            "text": "imipramine 25 mg tab",
                            "template": "imipramine 25 mg tab"
                        },
                        {
                            "text": "nortriptyline 25 mg cap",
                            "template": "nortriptyline 25 mg cap"
                        }
                    ]
                },
                {
                    "text": "Serotonin norepinephrine reuptake inhibitors (SNRIs)",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Cymbalta 60 mg DR cap",
                            "template": "Cymbalta 60 mg DR cap"
                        }
                    ]
                },
                {
                    "text": "Alpha adrenergic stimulants",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "pseudoephedrine 30 mg tab",
                            "template": "pseudoephedrine 30 mg tab"
                        }
                    ]
                },
                {
                    "text": "Antibiotics",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "ciprofloxacin 500 mg tab",
                            "template": "ciprofloxacin 500 mg tab"
                        },
                        {
                            "text": "ofloxacin 300 mg tab",
                            "template": "ofloxacin 300 mg tab"
                        },
                        {
                            "text": "trimethoprim\/sulfamethoxazole 160 mg\/800 mg tab",
                            "template": "trimethoprim\/sulfamethoxazole 160 mg\/800 mg tab"
                        },
                        {
                            "text": "Noroxin 400 mg tab",
                            "template": "Noroxin 400 mg tab"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Supplies, Equipment",
            "template": "{children}",
            "children": [
                {
                    "text": "Incontinenance pads",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Incontinence pads",
                            "template": "Incontinence pads"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Patient instructions",
            "template": "{children}",
            "children": [
                {
                    "text": "Patient provided with the following instructions:",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Bladder instruction training given (prompted\/timed voiding)",
                            "template": "Bladder instruction training given (prompted\/timed voiding)"
                        },
                        {
                            "text": "Lose weight to help alleviate symptoms",
                            "template": "Lose weight to help alleviate symptoms"
                        },
                        {
                            "text": "Restrict fluids, especially after 6 p.m.",
                            "template": "Restrict fluids, especially after 6 p.m."
                        },
                        {
                            "text": "Wear incontinence pad (to assess for incontinence that cannot be reproduced on\n                                exam)\n                            ",
                            "template": "Wear incontinence pad (to assess for incontinence that cannot be reproduced on\n                                exam)\n                            "
                        },
                        {
                            "text": "Eliminate\/reduce caffeine, carbonated beverages, highly acidic\/spicy foods",
                            "template": "Eliminate\/reduce caffeine, carbonated beverages, highly acidic\/spicy foods"
                        },
                        {
                            "text": "Keep a bladder diary",
                            "template": "Keep a bladder diary"
                        },
                        {
                            "text": "Recognize and manage constipation sx",
                            "template": "Recognize and manage constipation sx"
                        },
                        {
                            "text": "Quit smoking",
                            "template": "Quit smoking"
                        },
                        {
                            "text": "Pelvic floor muscle strengthening techniques given (Kegel exercises for men)",
                            "template": "Pelvic floor muscle strengthening techniques given (Kegel exercises for men)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Follow-up, Referrals",
            "template": "{children}",
            "children": [
                {
                    "text": "Return visits",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Return visit as needed",
                            "template": "Return visit as needed"
                        },
                        {
                            "text": "Return visit in 1 week",
                            "template": "Return visit in 1 week"
                        },
                        {
                            "text": "Return visit in 2 weeks",
                            "template": "Return visit in 2 weeks"
                        },
                        {
                            "text": "Return visit in 1 month",
                            "template": "Return visit in 1 month"
                        },
                        {
                            "text": "Return visit in 2 months",
                            "template": "Return visit in 2 months"
                        },
                        {
                            "text": "Return visit in 3 months",
                            "template": "Return visit in 3 months"
                        },
                        {
                            "text": "Return visit in 6 months",
                            "template": "Return visit in 6 months"
                        },
                        {
                            "text": "Return visit in 1 year",
                            "template": "Return visit in 1 year"
                        }
                    ]
                },
                {
                    "text": "Admit to ER\/inpatient care",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Admit to ER",
                            "template": "Admit to ER"
                        },
                        {
                            "text": "Admit to hospital",
                            "template": "Admit to hospital"
                        }
                    ]
                },
                {
                    "text": "Referrals",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Refer to Urology",
                            "template": "Refer to Urology"
                        },
                        {
                            "text": "Refer to Psychology for biofeedback",
                            "template": "Refer to Psychology for biofeedback"
                        },
                        {
                            "text": "Refer to smoking cessation program",
                            "template": "Refer to smoking cessation program"
                        }
                    ]
                }
            ]
        }
    ]
}