{
    "section": "subjective",
    "templateSet": "Urinary Incontinence",
    "templates": [
        {
            "text": "Referred by",
            "template": "Referred by: {text}",
            "type": "alpha"
        },
        {
            "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 incontinence symptoms",
                    "template": "initial evaluation of urinary incontinence symptoms"
                },
                {
                    "text": "follow-up incontinence evaluation",
                    "template": "follow-up urinary incontinence evaluation"
                },
                {
                    "text": "ongoing incontinence management",
                    "template": "ongoing urinary incontinence management"
                },
                {
                    "text": "urinary incontinence",
                    "template": "which occurs with {children}",
                    "children": [
                        {
                            "text": "urgency",
                            "template": "urgency"
                        },
                        {
                            "text": "physical exertion",
                            "template": "physical exertion"
                        },
                        {
                            "text": "no apparent cause",
                            "template": "no apparent cause"
                        }
                    ]
                },
                {
                    "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": "frequent need to urinate",
                    "children": [
                        {
                            "text": "every 3 to 4 hours",
                            "template": "approximately every 3 to 4 hours"
                        },
                        {
                            "text": "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 postponing urination",
                    "template": "difficulty postponing urination",
                    "type": "plus-minus"
                },
                {
                    "text": "difficulty initiating urine stream",
                    "template": "difficulty initiating urine stream",
                    "type": "plus-minus"
                },
                {
                    "text": "incontinence with cough\/sneeze",
                    "template": "incontinence with cough\/sneeze",
                    "type": "plus-minus"
                },
                {
                    "text": "incontinence related to urgency",
                    "template": "incontinence related to urgency",
                    "type": "plus-minus"
                },
                {
                    "text": "enuresis",
                    "template": "enuresis",
                    "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": "functional impact (describe)",
                    "template": "impaired functional status, described as {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "abdominal distension",
                    "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 sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "weakness",
                            "template": "LE weakness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "numbness",
                            "template": "LE numbness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "strength decreased",
                            "template": "LE strength decreased",
                            "type": "plus-minus"
                        },
                        {
                            "text": "paresthesias",
                            "template": "LE paresthesias",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "nausea",
                    "template": "nausea",
                    "type": "plus-minus"
                },
                {
                    "text": "pain",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "back pain",
                            "template": "back pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "flank pain",
                            "template": "flank pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "suprapubic pain",
                            "template": "suprapubic pain",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "symptoms with cough\/sneeze",
                    "template": "symptoms with cough\/sneeze",
                    "type": "plus-minus"
                },
                {
                    "text": "urine, foul-smelling",
                    "template": "foul-smelling urine",
                    "type": "plus-minus"
                },
                {
                    "text": "urine, cloudy",
                    "template": "cloudy urine",
                    "type": "plus-minus"
                },
                {
                    "text": "urine loss per episode",
                    "template": "{children} amount urine loss per episode",
                    "children": [
                        {
                            "text": "variable",
                            "template": "variable",
                            "type": "plus-minus"
                        },
                        {
                            "text": "small",
                            "template": "small",
                            "type": "plus-minus"
                        },
                        {
                            "text": "large",
                            "template": "large",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "urinary frequency",
                    "template": "urinary frequency",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary dribbling",
                    "template": "urinary dribbling",
                    "type": "plus-minus"
                },
                {
                    "text": "decreased perianal sensation",
                    "template": "decreased perianal sensation",
                    "type": "plus-minus"
                },
                {
                    "text": "other pertinent sx (describe)",
                    "template": "other symptoms: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Exacerbating\/Alleviating factors",
            "template": "Patient reports that {children}.",
            "children": [
                {
                    "text": "no exacerbating or ameliorating factors",
                    "template": "no exacerbating or ameliorating factors are noted"
                },
                {
                    "text": "artificial sweeteners",
                    "template": "artificial sweeteners {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": "caffeine",
                    "template": "caffeine {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": "carbonated beverages",
                    "template": "carbonated beverages {children}",
                    "children": [
                        {
                            "text": "worsen symptoms",
                            "template": "worsen symptoms"
                        },
                        {
                            "text": "improve symptoms",
                            "template": "improve symptoms"
                        },
                        {
                            "text": "have no effect on symptoms",
                            "template": "have no effect on symptoms"
                        }
                    ]
                },
                {
                    "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": "exercise",
                    "template": "exercise {children}",
                    "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": "difficulty getting to toilet in time",
                    "template": "difficulty getting to the toilet in time due to {children}",
                    "children": [
                        {
                            "text": "mobility problems",
                            "template": "mobility problems"
                        },
                        {
                            "text": "obstacles getting to the bathroom",
                            "template": "obstacles getting to the bathroom"
                        },
                        {
                            "text": "distance to the toilet from bed",
                            "template": "distance to the toilet from bed"
                        }
                    ]
                },
                {
                    "text": "infection",
                    "template": "an infection {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": "juices",
                    "template": "juices {children}",
                    "children": [
                        {
                            "text": "worsen symptoms",
                            "template": "worsen symptoms"
                        },
                        {
                            "text": "have no effect on symptoms",
                            "template": "have no effect on symptoms"
                        },
                        {
                            "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": "spicy foods",
                    "template": "spicy foods {children}",
                    "children": [
                        {
                            "text": "worsen symptoms",
                            "template": "worsen symptoms"
                        },
                        {
                            "text": "improve symptoms",
                            "template": "improve symptoms"
                        },
                        {
                            "text": "have no effect on symptoms",
                            "template": "have no effect on symptoms"
                        }
                    ]
                },
                {
                    "text": "timed voiding",
                    "template": "timed voiding {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been tried",
                            "template": "has not been tried"
                        }
                    ]
                },
                {
                    "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": "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": "diuretics",
                    "template": "diuretics {children}",
                    "children": [
                        {
                            "text": "worsen symptoms",
                            "template": "worsen symptoms"
                        },
                        {
                            "text": "improve symptoms",
                            "template": "improve symptoms"
                        },
                        {
                            "text": "have no effect on symptoms",
                            "template": "have no effect on 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": "other contributing factors (describe)",
                    "template": "contributing factors include {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Tx response\/Side effects",
            "template": "Treatment effects: {children}.",
            "children": [
                {
                    "text": "no tx 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 treatment"
                },
                {
                    "text": "nonadherent to current tx",
                    "template": "nonadherent to current treatment"
                },
                {
                    "text": "reasons for nonadherence",
                    "template": "reasons for nonadherence include {children}",
                    "children": [
                        {
                            "text": "side effects",
                            "template": "side effects"
                        },
                        {
                            "text": "cost",
                            "template": "cost"
                        },
                        {
                            "text": "diarrhea",
                            "template": "diarrhea"
                        },
                        {
                            "text": "difficulty scheduling",
                            "template": "difficulty scheduling"
                        },
                        {
                            "text": "forgetfulness",
                            "template": "forgetfulness"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea"
                        },
                        {
                            "text": "stomach upset",
                            "template": "stomach upset"
                        },
                        {
                            "text": "swallowing difficulty",
                            "template": "difficulty swallowing"
                        },
                        {
                            "text": "no perceived need for tx",
                            "template": "no perceived need for treatment"
                        }
                    ]
                },
                {
                    "text": "nonadherence (describe)",
                    "template": "nonadherent to tx ({text})",
                    "type": "alpha"
                },
                {
                    "text": "treatment response",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "resolved",
                            "template": "resolved with treatment"
                        },
                        {
                            "text": "well-controlled",
                            "template": "well-controlled on treatment"
                        },
                        {
                            "text": "improving",
                            "template": "improving on treatment"
                        },
                        {
                            "text": "stable",
                            "template": "stable on treatment"
                        },
                        {
                            "text": "unchanged",
                            "template": "unchanged on treatment"
                        },
                        {
                            "text": "variable response",
                            "template": "variable response to treatment"
                        },
                        {
                            "text": "suboptimally-controlled",
                            "template": "suboptimally-controlled on treatment"
                        },
                        {
                            "text": "poorly-controlled",
                            "template": "poorly-controlled on treatment"
                        },
                        {
                            "text": "worsening",
                            "template": "worsening on treatment"
                        },
                        {
                            "text": "exacerbated",
                            "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": "asthenia",
                            "template": "asthenia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "blurred vision",
                            "template": "blurred vision",
                            "type": "plus-minus"
                        },
                        {
                            "text": "constipation",
                            "template": "constipation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "decreased libido",
                            "template": "decreased libido",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dry eyes",
                            "template": "dry eyes",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dizziness\/vertigo",
                            "template": "dizziness\/vertigo",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dry mouth",
                            "template": "dry mouth",
                            "type": "plus-minus"
                        },
                        {
                            "text": "edema",
                            "template": "edema",
                            "type": "plus-minus"
                        },
                        {
                            "text": "impotence",
                            "template": "impotence",
                            "type": "plus-minus"
                        },
                        {
                            "text": "insomnia",
                            "template": "insomnia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "palpitations",
                            "template": "palpitations",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea\/vomiting",
                            "template": "nausea\/vomiting",
                            "type": "plus-minus"
                        },
                        {
                            "text": "somnolence",
                            "template": "somnolence",
                            "type": "plus-minus"
                        },
                        {
                            "text": "tachycardia",
                            "template": "tachycardia",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "side effects (describe)",
                    "template": "side effects: {text}",
                    "type": "alpha"
                },
                {
                    "text": "unable to tolerate",
                    "template": "unable to tolerate treatments attempted due to {children}",
                    "children": [
                        {
                            "text": "medical contraindications to treatment options",
                            "template": "medical contraindications to treatment options"
                        },
                        {
                            "text": "intolerable side effects of medications",
                            "template": "intolerable side effects of medications"
                        }
                    ]
                }
            ]
        },
        {
            "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": "indwelling urinary catheter",
                    "template": "indwelling urinary catheter",
                    "type": "plus-minus"
                },
                {
                    "text": "immunosuppression",
                    "template": "immunosuppression",
                    "type": "plus-minus"
                },
                {
                    "text": "multiple sclerosis",
                    "template": "multiple sclerosis",
                    "type": "plus-minus"
                },
                {
                    "text": "nephrolithiasis",
                    "template": "nephrolithiasis",
                    "type": "plus-minus"
                },
                {
                    "text": "pelvic irradiation",
                    "template": "hx of pelvic irradiation",
                    "type": "plus-minus"
                },
                {
                    "text": "pyelonephritis",
                    "template": "pyelonephritis",
                    "type": "plus-minus"
                },
                {
                    "text": "STD hx",
                    "template": "hx STD",
                    "type": "plus-minus"
                },
                {
                    "text": "renal insufficiency",
                    "template": "renal insufficiency",
                    "type": "plus-minus"
                },
                {
                    "text": "recurrent UTI",
                    "template": "recurrent UTI",
                    "type": "plus-minus"
                },
                {
                    "text": "pelvic surgery hx",
                    "template": "history of pelvic surgery includes {children}",
                    "children": [
                        {
                            "text": "abdominal prolapse repair",
                            "template": "previous abdominal prolapse repair"
                        },
                        {
                            "text": "hysterectomy",
                            "template": "hysterectomy"
                        },
                        {
                            "text": "incontinence surgery",
                            "template": "previous incontinence surgery"
                        },
                        {
                            "text": "prolapse surgery performed vaginally",
                            "template": "previous prolapse surgery performed vaginally"
                        },
                        {
                            "text": "radical pelvic surgery for cancer",
                            "template": "previous radical pelvic surgery for cancer"
                        }
                    ]
                },
                {
                    "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 includes",
                    "children": [
                        {
                            "text": "significant vaginal trauma w\/ delivery",
                            "template": "significant vaginal trauma with delivery"
                        },
                        {
                            "text": "3rd\/4th degree laceration w\/ delivery",
                            "template": "3rd or 4th degree laceration w\/ delivery"
                        }
                    ]
                },
                {
                    "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\/day",
                            "template": "tea (iced or hot) 1 or more per day",
                            "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": "carbonated beverage use",
                    "template": "use of carbonated beverages",
                    "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"
                }
            ]
        }
    ]
}