{
    "section": "plan",
    "templateSet": "Well Visit, Adult, Male",
    "templates": [
        {
            "text": "Labs",
            "template": "{children}",
            "children": [
                {
                    "text": "Blood Chemistry\/Hematology",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "CBC",
                            "template": "CBC"
                        },
                        {
                            "text": "CBC w\/ auto diff",
                            "template": "CBC w\/ auto diff"
                        },
                        {
                            "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": "Lipid panel",
                            "template": "Lipid panel"
                        },
                        {
                            "text": "Hepatic function panel (LFTs)",
                            "template": "Hepatic function panel (LFTs)"
                        },
                        {
                            "text": "Hepatitis screening panel",
                            "template": "Hepatitis screening panel"
                        },
                        {
                            "text": "Magnesium, serum",
                            "template": "Magnesium, serum"
                        },
                        {
                            "text": "Glucose, fasting, plasma",
                            "template": "Glucose, fasting, plasma"
                        },
                        {
                            "text": "Glucose, fingerstick",
                            "template": "Glucose, fingerstick"
                        },
                        {
                            "text": "Hemoglobin A1c (HbA1c), blood",
                            "template": "Hemoglobin A1c (HbA1c), blood"
                        },
                        {
                            "text": "TSH (thyroid-stimulating hormone), serum",
                            "template": "TSH (thyroid-stimulating hormone), serum"
                        },
                        {
                            "text": "Thyroxine (T4), free, serum",
                            "template": "Thyroxine (T4), free, serum"
                        },
                        {
                            "text": "PT (prothrombin time)",
                            "template": "PT (prothrombin time)"
                        },
                        {
                            "text": "PT\/INR",
                            "template": "PT\/INR"
                        },
                        {
                            "text": "Uric acid, serum",
                            "template": "Uric acid, serum"
                        },
                        {
                            "text": "Erythrocyte sedimentation rate (ESR)",
                            "template": "Erythrocyte sedimentation rate (ESR)"
                        },
                        {
                            "text": "C-reactive protein, high-sensitivity (hs-CRP), serum",
                            "template": "C-reactive protein, high-sensitivity (hs-CRP), serum"
                        },
                        {
                            "text": "Creatinine kinase (CK), serum",
                            "template": "Creatinine kinase (CK), serum"
                        },
                        {
                            "text": "Vitamin D, 25-OH, serum",
                            "template": "Vitamin D, 25-OH, serum"
                        },
                        {
                            "text": "Parathyroid hormone (PTH), serum",
                            "template": "Parathyroid hormone (PTH), serum"
                        },
                        {
                            "text": "PSA (prostate-specific antigen), serum",
                            "template": "PSA (prostate-specific antigen), serum"
                        },
                        {
                            "text": "HIV-1+HIV-2 antibody screen, serum",
                            "template": "HIV-1+HIV-2 antibody screen, serum"
                        },
                        {
                            "text": "CD4 T-cell count, blood",
                            "template": "CD4 T-cell count, blood"
                        },
                        {
                            "text": "RPR (rapid plasma reagin), serum",
                            "template": "RPR (rapid plasma reagin), serum"
                        },
                        {
                            "text": "FTA-ABS (fluorescent treponemal antibody absorption test)",
                            "template": "FTA-ABS (fluorescent treponemal antibody absorption test)"
                        }
                    ]
                },
                {
                    "text": "Urine tests",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Urinalysis, complete (with micro)",
                            "template": "Urinalysis, complete (with micro)"
                        },
                        {
                            "text": "Urine dipstick",
                            "template": "Urine dipstick"
                        },
                        {
                            "text": "Culture, urine, bacterial",
                            "template": "Culture, urine, bacterial"
                        },
                        {
                            "text": "Microalbumin, random, urine",
                            "template": "Microalbumin, random, urine"
                        }
                    ]
                },
                {
                    "text": "Microbiology\/Other Samples",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Fecal occult blood test (FOBT)",
                            "template": "Fecal occult blood test (FOBT)"
                        },
                        {
                            "text": "Fecal occult blood test (FOBT) kit",
                            "template": "Fecal occult blood test (FOBT) kit"
                        },
                        {
                            "text": "Fecal occult blood test (FOBT) performed",
                            "template": "Fecal occult blood test (FOBT) performed"
                        },
                        {
                            "text": "HIV-1+HIV-2 antibody screen, serum",
                            "template": "HIV-1+HIV-2 antibody screen, serum"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Imaging",
            "template": "{children}",
            "children": [
                {
                    "text": "Plain films",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "X-ray chest, PA and lateral",
                            "template": "X-ray chest, PA and lateral"
                        }
                    ]
                },
                {
                    "text": "Ultrasound",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "US abdominal aorta",
                            "template": "US abdominal aorta"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Procedures",
            "template": "{children}",
            "children": [
                {
                    "text": "Diagnostic Procedures",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Colonoscopy",
                            "template": "Colonoscopy"
                        },
                        {
                            "text": "Exercise treadmill test",
                            "template": "Exercise treadmill test"
                        },
                        {
                            "text": "EKG, 12-lead",
                            "template": "EKG, 12-lead"
                        },
                        {
                            "text": "EGD",
                            "template": "EGD"
                        },
                        {
                            "text": "Flexible sigmoidoscopy",
                            "template": "Flexible sigmoidoscopy"
                        },
                        {
                            "text": "PPD (purified protein derivative) skin test",
                            "template": "PPD (purified protein derivative) skin test"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Medications",
            "template": "{children}",
            "children": [
                {
                    "text": "Allergy, rash",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Antihistamine",
                            "template": "Antihistamine"
                        },
                        {
                            "text": "Intranasal corticosteroids",
                            "template": "Intranasal corticosteroids"
                        },
                        {
                            "text": "Topical steroids",
                            "template": "Topical steroids"
                        },
                        {
                            "text": "cetirizine 10 mg tab",
                            "template": "cetirizine 10 mg tab"
                        },
                        {
                            "text": "diphenhydramine 25 mg cap",
                            "template": "diphenhydramine 25 mg cap"
                        },
                        {
                            "text": "fexofenadine 180 mg tab",
                            "template": "fexofenadine 180 mg tab"
                        },
                        {
                            "text": "hydroxyzine 25 mg tab",
                            "template": "hydroxyzine 25 mg tab"
                        },
                        {
                            "text": "loratadine 10 mg tab",
                            "template": "loratadine 10 mg tab"
                        },
                        {
                            "text": "fluticasone propionate nasal 50 mcg per spray solution",
                            "template": "fluticasone propionate nasal 50 mcg per spray solution"
                        },
                        {
                            "text": "Nasonex 50 mcg per spray solution",
                            "template": "Nasonex 50 mcg per spray solution"
                        },
                        {
                            "text": "betamethasone valerate topical 0.1% cream",
                            "template": "betamethasone valerate topical 0.1% cream"
                        },
                        {
                            "text": "fluocinolone topical 0.01% cream",
                            "template": "fluocinolone topical 0.01% cream"
                        },
                        {
                            "text": "hydrocortisone topical 1% cream",
                            "template": "hydrocortisone topical 1% cream"
                        },
                        {
                            "text": "triamcinolone topical 0.03% cream",
                            "template": "triamcinolone topical 0.03% cream"
                        }
                    ]
                },
                {
                    "text": "Analgesics",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "ibuprofen 400 mg tab",
                            "template": "ibuprofen 400 mg tab"
                        },
                        {
                            "text": "ibuprofen 600 mg tab",
                            "template": "ibuprofen 600 mg tab"
                        },
                        {
                            "text": "ibuprofen 800 mg tab",
                            "template": "ibuprofen 800 mg tab"
                        },
                        {
                            "text": "naproxen 250 mg tab",
                            "template": "naproxen 250 mg tab"
                        }
                    ]
                },
                {
                    "text": "Laxatives, Stool softeners",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "bisacodyl 5 mg EC tab",
                            "template": "bisacodyl 5 mg EC tab"
                        },
                        {
                            "text": "bisacodyl rectal 10 mg supp",
                            "template": "bisacodyl rectal 10 mg supp"
                        },
                        {
                            "text": "docusate sodium 100 mg cap",
                            "template": "docusate sodium 100 mg cap"
                        },
                        {
                            "text": "polyethylene glycol 3350 17 g solution",
                            "template": "polyethylene glycol 3350 17 g solution"
                        },
                        {
                            "text": "sennosides 8.6 mg tab",
                            "template": "sennosides 8.6 mg tab"
                        }
                    ]
                },
                {
                    "text": "Aspirin",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "aspirin 81 mg tab",
                            "template": "aspirin 81 mg tab"
                        }
                    ]
                },
                {
                    "text": "PPIs",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "lansoprazole 15 mg DR cap",
                            "template": "lansoprazole 15 mg DR cap"
                        },
                        {
                            "text": "omeprazole 20 mg DR cap",
                            "template": "omeprazole 20 mg DR cap"
                        },
                        {
                            "text": "pantoprazole 20 mg EC tab",
                            "template": "pantoprazole 20 mg EC tab"
                        },
                        {
                            "text": "Nexium 20 mg DR cap",
                            "template": "Nexium 20 mg DR cap"
                        }
                    ]
                },
                {
                    "text": "H2 blockers",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "cimetidine 400 mg tab",
                            "template": "cimetidine 400 mg tab"
                        },
                        {
                            "text": "famotidine 20 mg tab",
                            "template": "famotidine 20 mg tab"
                        },
                        {
                            "text": "nizatidine 150 mg cap",
                            "template": "nizatidine 150 mg cap"
                        },
                        {
                            "text": "ranitidine 150 mg cap",
                            "template": "ranitidine 150 mg cap"
                        }
                    ]
                },
                {
                    "text": "Smoking cessation",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "nicotine transdermal 7 mg per 24h patch",
                            "template": "nicotine transdermal 7 mg per 24h patch"
                        },
                        {
                            "text": "nicotine transdermal 14 mg per 24h patch",
                            "template": "nicotine transdermal 14 mg per 24h patch"
                        },
                        {
                            "text": "nicotine transdermal 21 mg per 24h patch",
                            "template": "nicotine transdermal 21 mg per 24h patch"
                        },
                        {
                            "text": "Chantix 0.5 mg tab",
                            "template": "Chantix 0.5 mg tab"
                        },
                        {
                            "text": "Zyban 150 mg ER tab",
                            "template": "Zyban 150 mg ER tab"
                        }
                    ]
                },
                {
                    "text": "Vitamins, Supplements",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "calcium carbonate 500 mg chew tab",
                            "template": "calcium carbonate 500 mg chew tab"
                        },
                        {
                            "text": "calcium carbonate 600 mg tab",
                            "template": "calcium carbonate 600 mg tab"
                        },
                        {
                            "text": "vitamin D3 (common name) 400 units cap",
                            "template": "vitamin D3 (common name) 400 units cap"
                        },
                        {
                            "text": "vitamin D3 (common name) 1000 units tab",
                            "template": "vitamin D3 (common name) 1000 units tab"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Immunizations",
            "template": "{children}",
            "children": [
                {
                    "text": "Immunizations",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Vaccination, hepatitis A",
                            "template": "Vaccination, hepatitis A"
                        },
                        {
                            "text": "Vaccination, hepatitis B",
                            "template": "Vaccination, hepatitis B"
                        },
                        {
                            "text": "Vaccination, influenza",
                            "template": "Vaccination, influenza"
                        },
                        {
                            "text": "Vaccination, MMR",
                            "template": "Vaccination, MMR"
                        },
                        {
                            "text": "Vaccination, meningococcus",
                            "template": "Vaccination, meningococcus"
                        },
                        {
                            "text": "Vaccination, pneumococcus",
                            "template": "Vaccination, pneumococcus"
                        },
                        {
                            "text": "Vaccination, tetanus",
                            "template": "Vaccination, tetanus"
                        },
                        {
                            "text": "Vaccination, varicella",
                            "template": "Vaccination, varicella"
                        },
                        {
                            "text": "Vaccination, zoster",
                            "template": "Vaccination, zoster"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Patient instructions",
            "template": "{children}",
            "children": [
                {
                    "text": "Patient instructions",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Follow a healthy diet rich in vegetables and low in salt\/saturated fats",
                            "template": "Follow a healthy diet rich in vegetables and low in salt\/saturated fats"
                        },
                        {
                            "text": "Get regular exercise (3x\/week or more)",
                            "template": "Get regular exercise (3x\/week or more)"
                        },
                        {
                            "text": "Implement any needed safety modifications for the home (including smoke detectors)\n                            ",
                            "template": "Implement any needed safety modifications for the home (including smoke detectors)\n                            "
                        }
                    ]
                }
            ]
        },
        {
            "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 year",
                            "template": "Return visit in 1 year"
                        }
                    ]
                },
                {
                    "text": "Referrals",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Refer to Allergy",
                            "template": "Refer to Allergy"
                        },
                        {
                            "text": "Refer to Audiology",
                            "template": "Refer to Audiology"
                        },
                        {
                            "text": "Refer to Cardiology",
                            "template": "Refer to Cardiology"
                        },
                        {
                            "text": "Refer to Dermatology",
                            "template": "Refer to Dermatology"
                        },
                        {
                            "text": "Refer to dietician",
                            "template": "Refer to dietician"
                        },
                        {
                            "text": "Refer to ENT",
                            "template": "Refer to ENT"
                        },
                        {
                            "text": "Refer to Hematology\/Oncology",
                            "template": "Refer to Hematology\/Oncology"
                        },
                        {
                            "text": "Refer to Endocrinology",
                            "template": "Refer to Endocrinology"
                        },
                        {
                            "text": "Refer to GI",
                            "template": "Refer to GI"
                        },
                        {
                            "text": "Refer to Nephrology",
                            "template": "Refer to Nephrology"
                        },
                        {
                            "text": "Refer to Neurology",
                            "template": "Refer to Neurology"
                        },
                        {
                            "text": "Refer to Nutrition",
                            "template": "Refer to Nutrition"
                        },
                        {
                            "text": "Refer to Occupational Therapy",
                            "template": "Refer to Occupational Therapy"
                        },
                        {
                            "text": "Refer to Ophthalmology",
                            "template": "Refer to Ophthalmology"
                        },
                        {
                            "text": "Refer to Orthopedic Surgery",
                            "template": "Refer to Orthopedic Surgery"
                        },
                        {
                            "text": "Refer to Pain Management",
                            "template": "Refer to Pain Management"
                        },
                        {
                            "text": "Refer to Physical Therapy",
                            "template": "Refer to Physical Therapy"
                        },
                        {
                            "text": "Refer to Psychiatry",
                            "template": "Refer to Psychiatry"
                        },
                        {
                            "text": "Refer to Pulmonary",
                            "template": "Refer to Pulmonary"
                        },
                        {
                            "text": "Refer to Rheumatology",
                            "template": "Refer to Rheumatology"
                        },
                        {
                            "text": "Refer to smoking cessation program",
                            "template": "Refer to smoking cessation program"
                        },
                        {
                            "text": "Refer to General Surgery",
                            "template": "Refer to General Surgery"
                        }
                    ]
                }
            ]
        }
    ]
}