{
    "section": "subjective",
    "templateSet": "Influenza",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "Patient presents for {children}.",
            "children": [
                {
                    "text": "New onset flu symptom evaluation",
                    "template": "evaluation of new onset symptoms"
                },
                {
                    "text": "Follow-up flu symptom evaluation",
                    "template": "follow-up flu symptom evaluation"
                },
                {
                    "text": "Visit reason (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Onset\/Time course",
            "template": "Condition {children}.",
            "children": [
                {
                    "text": "acute onset (new condition)",
                    "template": "is reported to have developed acutely"
                },
                {
                    "text": "chronic and ongoing condition",
                    "template": "is chronic and ongoing"
                },
                {
                    "text": "recurrent condition",
                    "template": "is recurrent"
                },
                {
                    "text": "Duration (hours)",
                    "template": "{text} hours of sx",
                    "type": "number"
                },
                {
                    "text": "Duration (days)",
                    "template": "{text} days of sx",
                    "type": "number"
                },
                {
                    "text": "Duration (weeks)",
                    "template": "{text} weeks of sx",
                    "type": "number"
                },
                {
                    "text": "Duration (describe)",
                    "template": "sx have been present for {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Symptoms",
            "template": "Patient reports the presence\/absence of the following Hx\/sx related to the current visit:\n                        {children}.\n                    ",
            "children": [
                {
                    "text": "fever present",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "subjective fever",
                    "template": "subjective fever",
                    "type": "plus-minus"
                },
                {
                    "text": "T max (Fahrenheit)",
                    "template": "T max {text} F",
                    "type": "number"
                },
                {
                    "text": "Cough",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "cough present",
                            "template": "cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "productive cough",
                            "template": "productive cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "minimal sputum",
                            "template": "(+)minimal sputum"
                        },
                        {
                            "text": "moderate or copious sputum",
                            "template": "(+)moderate or copious sputum"
                        },
                        {
                            "text": "clear sputum",
                            "template": "clear sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "white sputum",
                            "template": "white sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "yellow sputum",
                            "template": "yellow sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "green sputum",
                            "template": "green sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "blood-tinged sputum",
                            "template": "blood-tinged sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bloody sputum",
                            "template": "bloody sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "hemoptysis",
                            "template": "hemoptysis",
                            "type": "plus-minus"
                        },
                        {
                            "text": "plug-shaped sputum",
                            "template": "plug-shaped sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pain with cough",
                            "template": "pain with cough",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Constitutional, HEENT",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "chills",
                            "template": "chills",
                            "type": "plus-minus"
                        },
                        {
                            "text": "myalgias",
                            "template": "myalgias",
                            "type": "plus-minus"
                        },
                        {
                            "text": "arthralgias",
                            "template": "arthralgias",
                            "type": "plus-minus"
                        },
                        {
                            "text": "lethargy",
                            "template": "lethargy",
                            "type": "plus-minus"
                        },
                        {
                            "text": "sore throat",
                            "template": "sore throat",
                            "type": "plus-minus"
                        },
                        {
                            "text": "rhinorrhea",
                            "template": "rhinorrhea",
                            "type": "plus-minus"
                        },
                        {
                            "text": "ear pain",
                            "template": "ear pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "sinus pain",
                            "template": "sinus pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "sinus congestion",
                            "template": "sinus congestion",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cervical adenopathy",
                            "template": "cervical adenopathy",
                            "type": "plus-minus"
                        },
                        {
                            "text": "shortness of breath",
                            "template": "shortness of breath",
                            "type": "plus-minus"
                        },
                        {
                            "text": "fatigue",
                            "template": "fatigue",
                            "type": "plus-minus"
                        },
                        {
                            "text": "weakness",
                            "template": "weakness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "anorexia",
                            "template": "anorexia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "rash",
                            "template": "rash",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "nausea",
                    "template": "nausea",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "dysuria",
                    "template": "dysuria",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary frequency",
                    "template": "urinary frequency",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary hesitancy",
                    "template": "urinary hesitancy",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary urgency",
                    "template": "urinary urgency",
                    "type": "plus-minus"
                },
                {
                    "text": "back pain",
                    "template": "back pain",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "stiff neck",
                    "template": "stiff neck",
                    "type": "plus-minus"
                },
                {
                    "text": "seizure",
                    "template": "seizure",
                    "type": "plus-minus"
                },
                {
                    "text": "confusion",
                    "template": "confusion",
                    "type": "plus-minus"
                },
                {
                    "text": "pleuritic pain",
                    "template": "pleuritic pain",
                    "type": "plus-minus"
                },
                {
                    "text": "associated chest pain (location)",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "associated chest pain present",
                            "template": "(+)associated chest pain"
                        },
                        {
                            "text": "no associated chest pain",
                            "template": "(-)associated chest pain"
                        },
                        {
                            "text": "diffuse",
                            "template": "(+)diffuse associated chest pain"
                        },
                        {
                            "text": "left-sided",
                            "template": "(+)left-sided associated chest pain"
                        },
                        {
                            "text": "substernal",
                            "template": "(+)substernal associated chest pain"
                        },
                        {
                            "text": "right-sided",
                            "template": "(+)right-sided associated chest pain"
                        },
                        {
                            "text": "epigastric",
                            "template": "(+)epigastric associated chest pain"
                        },
                        {
                            "text": "pain present, unable to localize",
                            "template": "(+)associated chest pain but unable to localize"
                        }
                    ]
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Tx response\/Side effects",
            "template": "Treatment effects: {children}.",
            "children": [
                {
                    "text": "not on tx",
                    "template": "not on tx"
                },
                {
                    "text": "adherent to current tx",
                    "template": "adherent to current tx"
                },
                {
                    "text": "nonadherent to current tx",
                    "template": "nonadherent to current tx"
                },
                {
                    "text": "Treatment response",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "resolved with treatment",
                            "template": "resolved with treatment"
                        },
                        {
                            "text": "improving on treatment",
                            "template": "improving on treatment"
                        },
                        {
                            "text": "unchanged on treatment",
                            "template": "unchanged on treatment"
                        },
                        {
                            "text": "exacerbated despite treatment",
                            "template": "exacerbated despite treatment"
                        }
                    ]
                },
                {
                    "text": "Treatment response (describe)",
                    "template": "tx response {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical Hx specific to visit includes: {children}.",
            "children": [
                {
                    "text": "recent respiratory illness",
                    "template": "recent respiratory illness",
                    "type": "plus-minus"
                },
                {
                    "text": "asthma",
                    "template": "asthma",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes",
                    "template": "diabetes",
                    "type": "plus-minus"
                },
                {
                    "text": "COPD",
                    "template": "COPD",
                    "type": "plus-minus"
                },
                {
                    "text": "HIV",
                    "template": "HIV",
                    "type": "plus-minus"
                },
                {
                    "text": "alcoholism",
                    "template": "alcoholism",
                    "type": "plus-minus"
                },
                {
                    "text": "dementia",
                    "template": "dementia",
                    "type": "plus-minus"
                },
                {
                    "text": "sickle cell disease",
                    "template": "sickle cell disease",
                    "type": "plus-minus"
                },
                {
                    "text": "valvular heart disease",
                    "template": "valvular heart disease",
                    "type": "plus-minus"
                },
                {
                    "text": "pneumonectomy",
                    "template": "pneumonectomy",
                    "type": "plus-minus"
                },
                {
                    "text": "splenectomy",
                    "template": "splenectomy",
                    "type": "plus-minus"
                },
                {
                    "text": "active cancer (specify type)",
                    "template": "(+)active cancer ({text})",
                    "type": "alpha"
                },
                {
                    "text": "current chemotherapy",
                    "template": "current chemotherapy",
                    "type": "plus-minus"
                },
                {
                    "text": "other immunosupp (specify)",
                    "template": "(+)other immunosuppression ({text})",
                    "type": "alpha"
                },
                {
                    "text": "other medical Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environment factors",
            "template": "Lifestyle\/Environment factors include: {children}.",
            "children": [
                {
                    "text": "heavy ETOH use",
                    "template": "heavy ETOH use",
                    "type": "plus-minus"
                },
                {
                    "text": "LTCF resident",
                    "template": "LTCF resident",
                    "type": "plus-minus"
                },
                {
                    "text": "IV drug use",
                    "template": "IV drug use",
                    "type": "plus-minus"
                },
                {
                    "text": "other drug use",
                    "template": "other drug use",
                    "type": "plus-minus"
                },
                {
                    "text": "Occupation (describe)",
                    "template": "occupation is {text}",
                    "type": "alpha"
                },
                {
                    "text": "Recent travel (specify)",
                    "template": "(+) recent travel ({text})",
                    "type": "alpha"
                },
                {
                    "text": "Animals\/pets (specify)",
                    "template": "(+)animal\/pet exposure ({text})",
                    "type": "alpha"
                },
                {
                    "text": "Other lifestyle\/exposure (specify)",
                    "template": "other lifestyle\/exposure includes (+){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"
                }
            ]
        },
        {
            "text": "Immunization status",
            "template": "Immunization history: {children}",
            "children": [
                {
                    "text": "flu vaccine received this season",
                    "template": "flu vaccine received this season",
                    "type": "plus-minus"
                },
                {
                    "text": "pneumococcus vaccine current",
                    "template": "current pneumococcus vaccine",
                    "type": "plus-minus"
                },
                {
                    "text": "pertussis\/diphtheria current",
                    "template": "current pertussis\/diphtheria vaccine",
                    "type": "plus-minus"
                },
                {
                    "text": "other immunizations (specify)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}