{
    "section": "subjective",
    "templateSet": "EYE",
    "templates": [
        {
            "text": "Patient Type",
            "template": "Patient Type: {children}",
            "children": [
                {
                    "text": "new",
                    "template": "new"
                },
                {
                    "text": "existing",
                    "template": "existing"
                }
            ]
        },
        {
            "text": "Visit Type",
            "template": "Visit Type: {children}",
            "children": [
                {
                    "text": "WC",
                    "template": "WC"
                },
                {
                    "text": "UC",
                    "template": "UC"
                }
            ]
        },
        {
            "text": "Translator",
            "template": "Translator: {children}",
            "children": [
                {
                    "text": "no",
                    "template": "no"
                },
                {
                    "text": "yes",
                    "template": "yes"
                }
            ]
        },
        {
            "text": "Original Injury (date)",
            "template": "Date of Original Injury: {text}.",
            "type": "date"
        },
        {
            "text": "Onset\/Duration",
            "template": "Onset\/Duration: {children}.",
            "children": [
                {
                    "text": "today",
                    "template": "today"
                },
                {
                    "text": "yesterday",
                    "template": "yesterday"
                },
                {
                    "text": "duration (days)",
                    "template": "{text} days prior",
                    "type": "number"
                },
                {
                    "text": "duration (weeks)",
                    "template": "{text} weeks prior",
                    "type": "number"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Timing",
            "template": "Timing: {children}.",
            "children": [
                {
                    "text": "still present",
                    "template": "still present"
                },
                {
                    "text": "better",
                    "template": "better"
                },
                {
                    "text": "worse",
                    "template": "worse"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Severity",
            "template": "Severity: {children}.",
            "children": [
                {
                    "text": "mild",
                    "template": "mild"
                },
                {
                    "text": "moderate",
                    "template": "moderate"
                },
                {
                    "text": "worse",
                    "template": "worse"
                },
                {
                    "text": "pain scale rating (0-10, 10=worst)",
                    "template": "pain scale severity rating of {children}",
                    "children": [
                        {
                            "text": "0\/10 (no pain)",
                            "template": "0\/10 (no pain)"
                        },
                        {
                            "text": "+1\/10",
                            "template": "+1\/10 (10=worst)"
                        },
                        {
                            "text": "+2\/10",
                            "template": "+2\/10 (10=worst)"
                        },
                        {
                            "text": "+3\/10",
                            "template": "+3\/10 (10=worst)"
                        },
                        {
                            "text": "+4\/10",
                            "template": "+4\/10 (10=worst)"
                        },
                        {
                            "text": "+5\/10",
                            "template": "+5\/10 (10=worst)"
                        },
                        {
                            "text": "+6\/10",
                            "template": "+6\/10 (10=worst)"
                        },
                        {
                            "text": "+7\/10",
                            "template": "+7\/10 (10=worst)"
                        },
                        {
                            "text": "+8\/10",
                            "template": "+8\/10 (10=worst)"
                        },
                        {
                            "text": "+9\/10",
                            "template": "+9\/10 (10=worst)"
                        },
                        {
                            "text": "+10\/10",
                            "template": "+10\/10 (10=worst)"
                        }
                    ]
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Quality",
            "template": "Quality: {children}.",
            "children": [
                {
                    "text": "aching",
                    "template": "aching"
                },
                {
                    "text": "sharp",
                    "template": "sharp"
                },
                {
                    "text": "\"pain\"",
                    "template": "\"pain\""
                },
                {
                    "text": "burning",
                    "template": "burning"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Associated Sx",
            "template": "Associated Symptoms: {children}.",
            "children": [
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "chills",
                    "template": "chills",
                    "type": "plus-minus"
                },
                {
                    "text": "malaise",
                    "template": "malaise",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "redness",
                    "template": "redness",
                    "type": "plus-minus"
                },
                {
                    "text": "itching",
                    "template": "itching",
                    "type": "plus-minus"
                },
                {
                    "text": "discharge",
                    "template": "discharge",
                    "type": "plus-minus"
                },
                {
                    "text": "watery",
                    "template": "watery",
                    "type": "plus-minus"
                },
                {
                    "text": "visual changes",
                    "template": "visual changes",
                    "type": "plus-minus"
                },
                {
                    "text": "contact lenses",
                    "template": "contact lenses",
                    "type": "plus-minus"
                },
                {
                    "text": "floaters",
                    "template": "floaters",
                    "type": "plus-minus"
                },
                {
                    "text": "flashes",
                    "template": "flashes",
                    "type": "plus-minus"
                },
                {
                    "text": "double vision",
                    "template": "double vision",
                    "type": "plus-minus"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Primary Doctor (name)",
            "template": "Primary Doctor: {text}.",
            "type": "alpha"
        },
        {
            "text": "PMH\/SH\/Med, no change (date)",
            "template": "PMH\/SH\/Med no change from: {text}.",
            "type": "date"
        },
        {
            "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": "Occupation",
            "template": "Occupation: {children}.",
            "children": [
                {
                    "text": "full-time (+35hr\/wk)",
                    "template": "full-time (+35hr\/wk)"
                },
                {
                    "text": "part-time (regular)",
                    "template": "part-time (regular)"
                },
                {
                    "text": "part-time (irregular hrs\/day)",
                    "template": "part-time (irregular hrs\/day)"
                },
                {
                    "text": "unemployment",
                    "template": "unemployment"
                },
                {
                    "text": "retired\/disability",
                    "template": "retired\/disability"
                },
                {
                    "text": "in controlled environment",
                    "template": "in controlled environment"
                },
                {
                    "text": "homemaker",
                    "template": "homemaker"
                },
                {
                    "text": "student",
                    "template": "student"
                },
                {
                    "text": "medical leave",
                    "template": "medical leave"
                },
                {
                    "text": "military",
                    "template": "military"
                },
                {
                    "text": "national guard",
                    "template": "national guard"
                },
                {
                    "text": "type of work (describe)",
                    "template": "type of work:",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "FDLMP (date)",
            "template": "FDLMP: {text}.",
            "type": "date"
        },
        {
            "text": "Tetanus Status",
            "template": "Tetanus Status: {children}.",
            "children": [
                {
                    "text": "up to date",
                    "template": "up to date"
                },
                {
                    "text": "not up to date",
                    "template": "not up to date"
                },
                {
                    "text": "comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medications",
            "template": "Medications: {children}.",
            "children": [
                {
                    "text": "none",
                    "template": "none"
                },
                {
                    "text": "NSAID",
                    "template": "NSAID"
                },
                {
                    "text": "decongestant",
                    "template": "decongestant"
                },
                {
                    "text": "APAP",
                    "template": "APAP"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}