{
    "section": "subjective",
    "templateSet": "Otitis Media, Acute",
    "templates": [
        {
            "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 otitis symptoms",
                    "template": "initial evaluation of otitis symptoms"
                },
                {
                    "text": "follow-up evaluation of otitis",
                    "template": "follow-up evaluation of otitis"
                },
                {
                    "text": "ongoing management of otitis",
                    "template": "ongoing management of otitis"
                },
                {
                    "text": "Visit reason (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Location",
            "template": "Symptoms affecting {children}.",
            "children": [
                {
                    "text": "right",
                    "template": "the right ear"
                },
                {
                    "text": "left",
                    "template": "the left ear"
                },
                {
                    "text": "bilateral",
                    "template": "the left and right ear"
                }
            ]
        },
        {
            "text": "Onset\/Time course",
            "template": "Condition {children}.",
            "children": [
                {
                    "text": "acute onset (new condition)",
                    "template": "is reported to have developed acutely"
                },
                {
                    "text": "subacute",
                    "template": "is subacute"
                },
                {
                    "text": "chronic",
                    "template": "is chronic"
                },
                {
                    "text": "recurrent",
                    "template": "is recurrent"
                },
                {
                    "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": "Sx severity",
            "template": "Symptom severity is described as {children}.",
            "children": [
                {
                    "text": "mild",
                    "template": "mild"
                },
                {
                    "text": "moderate",
                    "template": "moderate"
                },
                {
                    "text": "severe",
                    "template": "severe"
                },
                {
                    "text": "severity scale (0-10)",
                    "template": "out of 10",
                    "children": [
                        {
                            "text": "0 (no pain)",
                            "template": "0 (no pain)"
                        },
                        {
                            "text": "1",
                            "template": "1"
                        },
                        {
                            "text": "2",
                            "template": "2"
                        },
                        {
                            "text": "3",
                            "template": "3"
                        },
                        {
                            "text": "4",
                            "template": "4"
                        },
                        {
                            "text": "5",
                            "template": "5"
                        },
                        {
                            "text": "6",
                            "template": "6"
                        },
                        {
                            "text": "7",
                            "template": "7"
                        },
                        {
                            "text": "8",
                            "template": "8"
                        },
                        {
                            "text": "9",
                            "template": "9"
                        },
                        {
                            "text": "10 (max pain)",
                            "template": "10 (max pain)"
                        }
                    ]
                },
                {
                    "text": "other pain severity",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Symptoms",
            "template": "Patient\/caregiver reports the presence\/absence of the following Hx\/sx related to the\n                        current visit: {children}.\n                    ",
            "children": [
                {
                    "text": "no complaints",
                    "template": "Patient has no complaints."
                },
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "ear pain",
                    "template": "ear pain",
                    "type": "plus-minus"
                },
                {
                    "text": "ear pulling",
                    "template": "ear pulling",
                    "type": "plus-minus"
                },
                {
                    "text": "hearing loss",
                    "template": "hearing loss",
                    "type": "plus-minus"
                },
                {
                    "text": "tinnitus",
                    "template": "tinnitus",
                    "type": "plus-minus"
                },
                {
                    "text": "swollen eyes",
                    "template": "swollen eyes",
                    "type": "plus-minus"
                },
                {
                    "text": "conjunctival injection",
                    "template": "conjunctival injection",
                    "type": "plus-minus"
                },
                {
                    "text": "other sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "general malaise",
                    "template": "general malaise",
                    "type": "plus-minus"
                },
                {
                    "text": "fatigue",
                    "template": "fatigue",
                    "type": "plus-minus"
                },
                {
                    "text": "lethargy",
                    "template": "lethargy",
                    "type": "plus-minus"
                },
                {
                    "text": "irritability",
                    "template": "irritability",
                    "type": "plus-minus"
                },
                {
                    "text": "crying",
                    "template": "crying",
                    "type": "plus-minus"
                },
                {
                    "text": "anorexia",
                    "template": "anorexia",
                    "type": "plus-minus"
                },
                {
                    "text": "vertigo",
                    "template": "vertigo",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "tinnitus",
                    "template": "tinnitus",
                    "type": "plus-minus"
                },
                {
                    "text": "sneezing",
                    "template": "sneezing",
                    "type": "plus-minus"
                },
                {
                    "text": "rhinorrhea",
                    "template": "rhinorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal congestion",
                    "template": "nasal congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal discharge",
                    "template": "nasal discharge",
                    "type": "plus-minus"
                },
                {
                    "text": "epistaxis",
                    "template": "epistaxis",
                    "type": "plus-minus"
                },
                {
                    "text": "post-nasal drip",
                    "template": "post-nasal drip",
                    "type": "plus-minus"
                },
                {
                    "text": "sore throat",
                    "template": "sore throat",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal discharge",
                    "template": "nasal discharge",
                    "type": "plus-minus"
                },
                {
                    "text": "frequent throat clearing",
                    "template": "frequent throat clearing",
                    "type": "plus-minus"
                },
                {
                    "text": "dyspnea",
                    "template": "dyspnea",
                    "type": "plus-minus"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "cough productive of sputum",
                    "template": "cough productive of sputum",
                    "type": "plus-minus"
                },
                {
                    "text": "clear sputum",
                    "template": "clear sputum",
                    "type": "plus-minus"
                },
                {
                    "text": "purulent sputum",
                    "template": "purulent sputum",
                    "type": "plus-minus"
                },
                {
                    "text": "blood-tinged sputum",
                    "template": "blood-tinged sputum",
                    "type": "plus-minus"
                },
                {
                    "text": "nausea",
                    "template": "nausea",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "other pertinent sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Infectious agents",
            "template": "Infectious agents present include {children}.",
            "children": [
                {
                    "text": "strep",
                    "template": "strep"
                },
                {
                    "text": "staph",
                    "template": "staph"
                },
                {
                    "text": "Scarlett fever",
                    "template": "Scarlett fever"
                },
                {
                    "text": "influenza",
                    "template": "influenza"
                },
                {
                    "text": "Measeles",
                    "template": "Measeles"
                },
                {
                    "text": "Mumps",
                    "template": "Mumps"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Exacerbating\/Alleviating factors",
            "template": "Patient\/caregiver reports that {children}.",
            "children": [
                {
                    "text": "Exposure to sick contacts",
                    "template": "exposure to sick contacts {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": "Viral illness",
                    "template": "viral illness {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": "Allergies",
                    "template": "allergies {children}",
                    "children": [
                        {
                            "text": "worsen sx",
                            "template": "worsen sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been observed",
                            "template": "have not been observed"
                        }
                    ]
                },
                {
                    "text": "Analgesic medications",
                    "template": "analgesic 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": "Antipyretic medications",
                    "template": "antipyretic 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": "Antimicrobial medications",
                    "template": "antimicrobial 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": "Other contributing factors (describe)",
                    "template": "contributing factors include {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Tx response",
            "template": "Treatment effects: {children}.",
            "children": [
                {
                    "text": "adherent to current tx",
                    "template": "adherent to current tx"
                },
                {
                    "text": "nonadherent to current tx",
                    "template": "nonadherent to current tx"
                },
                {
                    "text": "reasons for nonadherence",
                    "template": "reasons for nonadherence include {children}",
                    "children": [
                        {
                            "text": "side effects",
                            "template": "side effects"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea"
                        },
                        {
                            "text": "stomach upset",
                            "template": "stomach upset"
                        },
                        {
                            "text": "diarrhea",
                            "template": "diarrhea"
                        },
                        {
                            "text": "swallowing difficulty",
                            "template": "difficulty swallowing"
                        },
                        {
                            "text": "cost",
                            "template": "cost"
                        },
                        {
                            "text": "difficulty scheduling",
                            "template": "difficulty scheduling"
                        },
                        {
                            "text": "forgetfulness",
                            "template": "forgetfulness"
                        },
                        {
                            "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 with treatment",
                            "template": "resolved with treatment"
                        },
                        {
                            "text": "well-controlled on treatment",
                            "template": "well-controlled on treatment"
                        },
                        {
                            "text": "improving on treatment",
                            "template": "improving on treatment"
                        },
                        {
                            "text": "stable on treatment",
                            "template": "stable on treatment"
                        },
                        {
                            "text": "unchanged on treatment",
                            "template": "unchanged on treatment"
                        },
                        {
                            "text": "variable response to treatment",
                            "template": "variable response to treatment"
                        },
                        {
                            "text": "suboptimally-controlled on treatment",
                            "template": "suboptimally-controlled on treatment"
                        },
                        {
                            "text": "poorly-controlled on treatment",
                            "template": "poorly-controlled on treatment"
                        },
                        {
                            "text": "worsening on treatment",
                            "template": "worsening on treatment"
                        },
                        {
                            "text": "exacerbated despite treatment",
                            "template": "exacerbated despite treatment"
                        }
                    ]
                },
                {
                    "text": "treatment response (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "Hx otitis media",
                    "template": "Hx otitis media",
                    "type": "plus-minus"
                },
                {
                    "text": "recent antibiotic use",
                    "template": "recent antibiotic use",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx ear infections",
                    "template": "Hx ear infections",
                    "type": "plus-minus"
                },
                {
                    "text": "other medical Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environment factors",
            "template": "Lifestyle\/Environment factors include {children}.",
            "children": [
                {
                    "text": "sick siblings",
                    "template": "sick siblings",
                    "type": "plus-minus"
                },
                {
                    "text": "ill contacts",
                    "template": "ill contacts",
                    "type": "plus-minus"
                },
                {
                    "text": "daycare attendance",
                    "template": "daycare attendance",
                    "type": "plus-minus"
                },
                {
                    "text": "non-breastfed infant",
                    "template": "non-breastfed infant",
                    "type": "plus-minus"
                },
                {
                    "text": "sleeping with bottle",
                    "template": "sleeping with bottle",
                    "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"
                }
            ]
        }
    ]
}