{
    "section": "mental-functional",
    "templateSet": "Medicare IPPE",
    "templates": [
        {
            "text": "Assistance with ADL's",
            "template": "Functional Ability\/Safety Screen1. Does the patient need help with the phone,\n                        transportation, shopping, preparing meals, housework, laundry, medications or managing money?\n                        {children}\n                    ",
            "children": [
                {
                    "text": "No",
                    "template": "No"
                },
                {
                    "text": "Yes",
                    "template": "Yes"
                }
            ]
        },
        {
            "text": "Safety, rugs\/lacks grab bars\/handrails\/poor light",
            "template": "2. Does the patient's home have rugs in the hallway, lack grab bars in the bathroom, lack\n                        handrails on the stairs or have poor lighting? {children}\n                    ",
            "children": [
                {
                    "text": "No",
                    "template": "No"
                },
                {
                    "text": "Yes",
                    "template": "Yes"
                }
            ]
        },
        {
            "text": "Patient noticed any hearing difficulties",
            "template": "3. Has the patient noticed any hearing difficulties? {children}",
            "children": [
                {
                    "text": "No",
                    "template": "No"
                },
                {
                    "text": "Yes",
                    "template": "Yes"
                }
            ]
        },
        {
            "text": "Fall Screening",
            "template": "Fall Screening: {children}",
            "children": [
                {
                    "text": "falls in the the past year (#)",
                    "template": "{text} fall(s) in the past year",
                    "type": "number"
                },
                {
                    "text": "timed \"Up and Go\" test",
                    "template": "timed \"Up and Go\" test",
                    "children": [
                        {
                            "text": "less than 30 seconds",
                            "template": "less than 30 seconds"
                        },
                        {
                            "text": "greater than 30 seconds",
                            "template": "greater than 30 seconds"
                        }
                    ]
                },
                {
                    "text": "other fall assessment findings (comments)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Functional Concerns: Beneficiary or Caretaker",
            "template": "Functional concerns from beneficiary or caretaker include: {text}.",
            "type": "alpha"
        }
    ]
}
