{
    "section": "plan",
    "templateSet": "Contraception",
    "templates": [
        {
            "text": "Ordered Labs",
            "template": "Ordered Labs {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": "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": "Beta-hCG, qualitative, serum",
                            "template": "Beta-hCG, qualitative, serum"
                        },
                        {
                            "text": "Pap smear",
                            "template": "Pap smear"
                        }
                    ]
                },
                {
                    "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": "Beta-hCG, qualitative, urine",
                            "template": "Beta-hCG, qualitative, urine"
                        },
                        {
                            "text": "Chlamydia trachomatis, nucleic acid amplification, urine",
                            "template": "Chlamydia trachomatis, nucleic acid amplification, urine"
                        }
                    ]
                },
                {
                    "text": "Microbiology\/Other Samples",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Fecal occult blood test (FOBT)",
                            "template": "Fecal occult blood test (FOBT)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Ordered Imaging",
            "template": "Ordered Imaging{children}",
            "children": [
                {
                    "text": "Plain films",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "X-ray chest, PA and lateral",
                            "template": "X-ray chest, PA and lateral"
                        }
                    ]
                },
                {
                    "text": "Breast imaging",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Mammogram, diagnostic",
                            "template": "Mammogram, diagnostic"
                        },
                        {
                            "text": "Mammogram, screening",
                            "template": "Mammogram, screening"
                        }
                    ]
                },
                {
                    "text": "Osteoporosis screening",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Bone densitometry (DXA)",
                            "template": "Bone densitometry (DXA)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Ordered Medications",
            "template": "Ordered Medications{children}",
            "children": [
                {
                    "text": "Oral contraceptives",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Monophasic OCPs",
                            "template": "Monophasic OCPs"
                        },
                        {
                            "text": "Biphasic OCPs",
                            "template": "Biphasic OCPs"
                        },
                        {
                            "text": "Triphasic OCPs",
                            "template": "Triphasic OCPs"
                        },
                        {
                            "text": "Progestin-only OCPs",
                            "template": "Progestin-only OCPs"
                        },
                        {
                            "text": "Brevicon 35 mcg\/0.5 mg [28 day] pack",
                            "template": "Brevicon 35 mcg\/0.5 mg [28 day] pack"
                        },
                        {
                            "text": "Lo Loestrin Fe monophasic [28 day] pack",
                            "template": "Lo Loestrin Fe monophasic [28 day] pack"
                        },
                        {
                            "text": "Loestrin 24 Fe 20 mcg\/1 mg [28 day] pack",
                            "template": "Loestrin 24 Fe 20 mcg\/1 mg [28 day] pack"
                        },
                        {
                            "text": "Lo\/Ovral-28 monophasic [28 day] pack",
                            "template": "Lo\/Ovral-28 monophasic [28 day] pack"
                        },
                        {
                            "text": "Modicon 35 mcg\/0.5 mg [28 day] pack",
                            "template": "Modicon 35 mcg\/0.5 mg [28 day] pack"
                        },
                        {
                            "text": "Ocella 3 mg\/30 mcg [28 day] pack",
                            "template": "Ocella 3 mg\/30 mcg [28 day] pack"
                        },
                        {
                            "text": "Ortho-Cyclen 35 mcg\/0.25 mg [28 day] pack",
                            "template": "Ortho-Cyclen 35 mcg\/0.25 mg [28 day] pack"
                        },
                        {
                            "text": "Ortho-Novum 1\/35 35 mcg\/1 mg [28 day] pack",
                            "template": "Ortho-Novum 1\/35 35 mcg\/1 mg [28 day] pack"
                        },
                        {
                            "text": "Yasmin monophasic [28 day] pack",
                            "template": "Yasmin monophasic [28 day] pack"
                        },
                        {
                            "text": "Yaz 3 mg\/20 mcg [28 day] pack",
                            "template": "Yaz 3 mg\/20 mcg [28 day] pack"
                        },
                        {
                            "text": "Necon 10\/11 biphasic [28 day] pack",
                            "template": "Necon 10\/11 biphasic [28 day] pack"
                        },
                        {
                            "text": "Ortho Tri-Cyclen Lo triphasic [28 day] pack",
                            "template": "Ortho Tri-Cyclen Lo triphasic [28 day] pack"
                        },
                        {
                            "text": "Ortho Tri-Cyclen triphasic [28 day] pack",
                            "template": "Ortho Tri-Cyclen triphasic [28 day] pack"
                        },
                        {
                            "text": "TriNessa triphasic [28 day] pack",
                            "template": "TriNessa triphasic [28 day] pack"
                        },
                        {
                            "text": "Ortho Micronor 0.35 mg [28 day] pack",
                            "template": "Ortho Micronor 0.35 mg [28 day] pack"
                        }
                    ]
                },
                {
                    "text": "Oral contraceptives extended cycle",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Jolessa monophasic [91 day] pack",
                            "template": "Jolessa monophasic [91 day] pack"
                        },
                        {
                            "text": "Lybrel monophasic [28 day] pack",
                            "template": "Lybrel monophasic [28 day] pack"
                        },
                        {
                            "text": "Seasonique biphasic [91 day] pack",
                            "template": "Seasonique biphasic [91 day] pack"
                        },
                        {
                            "text": "Seasonale 30 mcg\/0.15 mg [91 day] pack",
                            "template": "Seasonale 30 mcg\/0.15 mg [91 day] pack"
                        }
                    ]
                },
                {
                    "text": "Contraceptive patch, ring, IUD, injection",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "medroxyprogesterone acetate INJ",
                            "template": "medroxyprogesterone acetate INJ"
                        },
                        {
                            "text": "Depo-Provera INJ",
                            "template": "Depo-Provera INJ"
                        },
                        {
                            "text": "NuvaRing 0.12 mg\/0.015 mg per day ring",
                            "template": "NuvaRing 0.12 mg\/0.015 mg per day ring"
                        },
                        {
                            "text": "Mirena 52 mg IUD",
                            "template": "Mirena 52 mg IUD"
                        },
                        {
                            "text": "Ortho Evra 150 mcg\/20 mcg per 24h patch",
                            "template": "Ortho Evra 150 mcg\/20 mcg per 24h patch"
                        }
                    ]
                },
                {
                    "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": "folic acid 0.4 mg tab",
                            "template": "folic acid 0.4 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": "Ordered Immunizations",
            "template": "Ordered Immunizations{children}",
            "children": [
                {
                    "text": "Immunizations",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Vaccination, influenza",
                            "template": "Vaccination, influenza"
                        },
                        {
                            "text": "Vaccination, HPV",
                            "template": "Vaccination, HPV"
                        },
                        {
                            "text": "Vaccination, hepatitis A",
                            "template": "Vaccination, hepatitis A"
                        },
                        {
                            "text": "Vaccination, hepatitis B",
                            "template": "Vaccination, hepatitis B"
                        },
                        {
                            "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": "Ordered Procedures",
            "template": "Ordered Procedures{children}",
            "children": [
                {
                    "text": "Procedures",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Colonoscopy",
                            "template": "Colonoscopy"
                        },
                        {
                            "text": "Flexible sigmoidoscopy",
                            "template": "Flexible sigmoidoscopy"
                        },
                        {
                            "text": "EKG, 12-lead",
                            "template": "EKG, 12-lead"
                        },
                        {
                            "text": "Exercise treadmill test",
                            "template": "Exercise treadmill test"
                        },
                        {
                            "text": "EGD",
                            "template": "EGD"
                        },
                        {
                            "text": "PPD (purified protein derivative) skin test",
                            "template": "PPD (purified protein derivative) skin test"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Patient Instructions",
            "template": "Patient Instructions{children}",
            "children": [
                {
                    "text": "Patient instructions",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Follow healthy diet",
                            "template": "Follow healthy diet"
                        },
                        {
                            "text": "Regular exercise (3x\/week or more)",
                            "template": "Regular exercise (3x\/week or more)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Follow-up, Referrals",
            "template": "Follow Up, Referrals{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 Endocrinology",
                            "template": "Refer to Endocrinology"
                        },
                        {
                            "text": "Refer to Dermatology",
                            "template": "Refer to Dermatology"
                        },
                        {
                            "text": "Refer to dietician",
                            "template": "Refer to dietician"
                        },
                        {
                            "text": "Refer to Nutrition",
                            "template": "Refer to Nutrition"
                        },
                        {
                            "text": "Refer to OB\/Gyn",
                            "template": "Refer to OB\/Gyn"
                        },
                        {
                            "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 smoking cessation program",
                            "template": "Refer to smoking cessation program"
                        }
                    ]
                }
            ]
        }
    ]
}