{
    "section": "mental-functional",
    "templateSet": "Medicare Subsequent Annual Well Visit",
    "templates": [
        {
            "text": "Normal MSE By Direct Observation",
            "template": "The patient's speech was normal, sharing conversation with normal laryngeal efforts.\n                        Appropriate mood and affect were seen on exam. Thought processes were logical, relevant, and\n                        thoughts were completed normally. Thought content was normal. Thought content was normal with no\n                        psychotic or suicidal thoughts. The patient's judgement was realistic with normal insight into\n                        their present condition. Mental status included: correct time, place, person orientation, normal\n                        recent and remote memory, normal attention span and concentration ability. Language skills\n                        included the ability to correctly name objects. Fund of knowledge included normal awareness of\n                        current and past events.\n                    "
        },
        {
            "text": "MSE (findings)",
            "template": "MSE: {text}.",
            "type": "alpha"
        },
        {
            "text": "Mini Cog",
            "template": "Mini Cog test: {children}",
            "children": [
                {
                    "text": "normal",
                    "template": "normal"
                },
                {
                    "text": "abnormal",
                    "template": "abnormal"
                },
                {
                    "text": "additional mini cog findings (describe)",
                    "template": "additional mini cog findings: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Mood\/Affect (describe)",
            "template": "Mood\/Affect is described as: {text}.",
            "type": "alpha"
        },
        {
            "text": "Cognitive Concerns: Beneficiary or Caretaker",
            "template": "Cognitive concerns from beneficiary or caretaker include: {text}.",
            "type": "alpha"
        },
        {
            "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"
        },
        {
            "text": "Reviewed HRA\/Copy of HRA in documents section",
            "template": "Reviewed HRA. Copy of HRA in documents section."
        }
    ]
}
