{
    "section": "subjective",
    "templateSet": "Colposcopy Note",
    "templates": [
        {
            "text": "Referred by",
            "template": "Referred by: {text}",
            "type": "alpha"
        },
        {
            "text": "Reason for colposcopy",
            "template": "Reason for colposcopy: {children}.",
            "children": [
                {
                    "text": "ASC-US with high risk HPV",
                    "template": "ASC-US with high risk HPV"
                },
                {
                    "text": "low-grade squamous intraepithelial lesion",
                    "template": "low-grade squamous intraepithelial lesion"
                },
                {
                    "text": "high-grade squamous intraepithelial lesion",
                    "template": "high-grade squamous intraepithelial lesion"
                },
                {
                    "text": "atypical squamous cells",
                    "template": "atypical squamous cells"
                },
                {
                    "text": "atypical glandular cells",
                    "template": "atypical glandular cells"
                },
                {
                    "text": "abnormal pelvic exam (describe)",
                    "template": "abnormal pelvic exam:",
                    "type": "alpha"
                },
                {
                    "text": "follow up colposcopy",
                    "template": "follow up colposcopy"
                },
                {
                    "text": "other reason for visit (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "LMP\/Bleeding\/Pain",
            "template": "Patient reports {children}.",
            "children": [
                {
                    "text": "LMP began (specify date)",
                    "template": "last menses began {text}",
                    "type": "date"
                },
                {
                    "text": "LMP (describe)",
                    "template": "last menses: {text}",
                    "type": "alpha"
                },
                {
                    "text": "LMP >1 year ago",
                    "template": "last menses was over a year ago"
                },
                {
                    "text": "currently menstruating",
                    "template": "currently menstruating"
                },
                {
                    "text": "currently pregnant",
                    "template": "currently pregnant",
                    "type": "plus-minus"
                },
                {
                    "text": "postmenopausal",
                    "template": "postmenopausal"
                },
                {
                    "text": "bleeding duration per cycle (specify days)",
                    "template": "bleeding duration per cycle is {text} days",
                    "type": "number"
                },
                {
                    "text": "frequency of menses",
                    "template": "frequency of menses is {children}",
                    "children": [
                        {
                            "text": "regular cycles",
                            "template": "regular cycles"
                        },
                        {
                            "text": "irregular cycles",
                            "template": "irregular cycles"
                        },
                        {
                            "text": "monthly",
                            "template": "monthly"
                        },
                        {
                            "text": "monthly w\/ skipped cycles",
                            "template": "monthly with skipped cycles"
                        },
                        {
                            "text": "monthly w\/ some extra cycles",
                            "template": "monthly with some extra cycles"
                        },
                        {
                            "text": "every 2 weeks",
                            "template": "every 2 weeks"
                        },
                        {
                            "text": "every 3 weeks",
                            "template": "every 3 weeks"
                        },
                        {
                            "text": "every 5 weeks",
                            "template": "every 5 weeks"
                        },
                        {
                            "text": "every 6 weeks",
                            "template": "every 6 weeks"
                        },
                        {
                            "text": "every 8 weeks",
                            "template": "every 8 weeks"
                        },
                        {
                            "text": "every few months",
                            "template": "every few months"
                        },
                        {
                            "text": "no discernable pattern noted",
                            "template": "no discernable pattern noted"
                        },
                        {
                            "text": "postmenopausal",
                            "template": "postmenopausal"
                        }
                    ]
                },
                {
                    "text": "menstrual and other bleeding",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "heavy menses",
                            "template": "heavy menses",
                            "type": "plus-minus"
                        },
                        {
                            "text": "heavy bleeding with clots",
                            "template": "heavy bleeding with clots",
                            "type": "plus-minus"
                        },
                        {
                            "text": "copious bright red blood",
                            "template": "copious bright red blood",
                            "type": "plus-minus"
                        },
                        {
                            "text": "increased bleeding duration",
                            "template": "increased bleeding duration",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding between periods",
                            "template": "bleeding between periods",
                            "type": "plus-minus"
                        },
                        {
                            "text": "new bleeding after cessation menses",
                            "template": "new bleeding after cessation menses",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding after intercourse",
                            "template": "bleeding after intercourse",
                            "type": "plus-minus"
                        },
                        {
                            "text": "significant pain w\/ menses",
                            "template": "significant pain w\/ menses",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "symptom onset",
                    "template": "symptoms began {children}",
                    "children": [
                        {
                            "text": "in the past week",
                            "template": "in the past week"
                        },
                        {
                            "text": "in the past few weeks",
                            "template": "in the past few weeks"
                        },
                        {
                            "text": "in the past few months",
                            "template": "in the past few months"
                        },
                        {
                            "text": "in the past 12 months",
                            "template": "in the past 12 months"
                        },
                        {
                            "text": "over the past few years",
                            "template": "over the past few years"
                        },
                        {
                            "text": "over many years",
                            "template": "many years ago"
                        },
                        {
                            "text": "ever since menarche",
                            "template": "ever since menarche"
                        }
                    ]
                },
                {
                    "text": "pain sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "pelvic pain",
                            "template": "pelvic pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cramping",
                            "template": "cramping",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dysuria",
                            "template": "dysuria",
                            "type": "plus-minus"
                        },
                        {
                            "text": "painful intercourse",
                            "template": "painful intercourse",
                            "type": "plus-minus"
                        },
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "age at menopause (specify)",
                    "template": "menopause at {text} years old",
                    "type": "number"
                },
                {
                    "text": "other symptoms (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Sexual Hx\/activity",
            "template": "Sexual Hx: {children}.",
            "children": [
                {
                    "text": ">4 sex partners in lifetime",
                    "template": ">4 sex partners in lifetime"
                },
                {
                    "text": "4 or fewer sex partners in lifetime",
                    "template": "4 or fewer sex partners in lifetime"
                },
                {
                    "text": "number of partners, lifetime",
                    "template": "number of partners, lifetime: {text}",
                    "type": "number"
                },
                {
                    "text": "sexually active",
                    "template": "sexually active",
                    "type": "plus-minus"
                },
                {
                    "text": "safe sex practices",
                    "template": "safe sex practices",
                    "type": "plus-minus"
                },
                {
                    "text": "sexual symptoms",
                    "template": "sexual sx: {children}",
                    "children": [
                        {
                            "text": "loss of interest in sex",
                            "template": "loss of interest in sex",
                            "type": "plus-minus"
                        },
                        {
                            "text": "loss of sexual pleasure",
                            "template": "loss of sexual pleasure",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pain w\/ intercourse",
                            "template": "pain w\/ intercourse",
                            "type": "plus-minus"
                        },
                        {
                            "text": "vaginal dryness",
                            "template": "vaginal dryness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding after intercourse",
                            "template": "bleeding after intercourse",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "sexual partners are male",
                    "template": "sexual partners are male"
                },
                {
                    "text": "sexual partners are female",
                    "template": "sexual partners are female"
                },
                {
                    "text": "sexual partners are male and female",
                    "template": "sexual partners are male and female"
                },
                {
                    "text": "abuse concerns (describe)",
                    "template": "abuse concerns: {text}",
                    "type": "alpha"
                },
                {
                    "text": "additional comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Contraception use\/side effects",
            "template": "Contraception: {children}.",
            "children": [
                {
                    "text": "not currently on contraception",
                    "template": "patient not currently on contraception"
                },
                {
                    "text": "birth control type",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "oral contraceptives",
                            "template": "oral contraceptives"
                        },
                        {
                            "text": "monophasic oral contraceptives",
                            "template": "monophasic oral contraceptives"
                        },
                        {
                            "text": "biphasic oral contraceptives",
                            "template": "biphasic oral contraceptives"
                        },
                        {
                            "text": "triphasic oral contraceptives",
                            "template": "triphasic oral contraceptives"
                        },
                        {
                            "text": "extended cycle oral contraceptives",
                            "template": "extended cycle oral contraceptives"
                        },
                        {
                            "text": "progestin-only oral contraceptives",
                            "template": "progestin-only oral contraceptives"
                        },
                        {
                            "text": "hormonal patch",
                            "template": "hormonal patch"
                        },
                        {
                            "text": "male condom",
                            "template": "male condom"
                        },
                        {
                            "text": "female condom",
                            "template": "female condom"
                        },
                        {
                            "text": "diaphragm",
                            "template": "diaphragm"
                        },
                        {
                            "text": "spermicide",
                            "template": "spermicide"
                        },
                        {
                            "text": "vaginal ring",
                            "template": "vaginal ring"
                        },
                        {
                            "text": "cervical cap",
                            "template": "cervical cap"
                        },
                        {
                            "text": "contraceptive sponge",
                            "template": "contraceptive sponge"
                        },
                        {
                            "text": "IUD",
                            "template": "IUD"
                        },
                        {
                            "text": "intradermal implant",
                            "template": "intradermal implant"
                        },
                        {
                            "text": "monthly injection",
                            "template": "monthly injection"
                        },
                        {
                            "text": "rhythm method\/fertility awareness",
                            "template": "rhythm method\/fertility awareness"
                        },
                        {
                            "text": "emergency contraceptive pills",
                            "template": "emergency contraceptive pills"
                        },
                        {
                            "text": "partner is sterilized",
                            "template": "partner is sterilized"
                        }
                    ]
                },
                {
                    "text": "birth control type (specify)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "satisfied with current contraception",
                    "template": "satisfied with current contraception"
                },
                {
                    "text": "consistent contraception use",
                    "template": "consistent contraception use",
                    "type": "plus-minus"
                },
                {
                    "text": "no side effects noted",
                    "template": "no side effects noted"
                },
                {
                    "text": "common contraception side effects",
                    "template": "side effects include: {children}",
                    "children": [
                        {
                            "text": "weight gain",
                            "template": "weight gain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding between periods",
                            "template": "bleeding between periods",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea",
                            "type": "plus-minus"
                        },
                        {
                            "text": "breast tenderness",
                            "template": "breast tenderness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "headache",
                            "template": "headache",
                            "type": "plus-minus"
                        },
                        {
                            "text": "patch application site irritation",
                            "template": "patch application site irritation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bloating",
                            "template": "bloating",
                            "type": "plus-minus"
                        },
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "lower extremity edema",
                            "template": "lower extremity edema",
                            "type": "plus-minus"
                        },
                        {
                            "text": "emotional instability",
                            "template": "emotional instability",
                            "type": "plus-minus"
                        },
                        {
                            "text": "acne",
                            "template": "acne",
                            "type": "plus-minus"
                        },
                        {
                            "text": "melasma",
                            "template": "melasma",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "side effects (describe)",
                    "template": "side effects: {text}",
                    "type": "alpha"
                },
                {
                    "text": "additional comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pregnancy Test Results",
            "template": "Pregnancy Test Results: {children}.",
            "children": [
                {
                    "text": "negative",
                    "template": "negative"
                },
                {
                    "text": "positive",
                    "template": "positive"
                },
                {
                    "text": "other comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Screening\/Treatment hx",
            "template": "Screening\/Treatment hx: {children}.",
            "children": [
                {
                    "text": "Pap test (detail)",
                    "template": "Pap test: {text}",
                    "type": "alpha"
                },
                {
                    "text": "Pap test (detail)",
                    "template": "Pap test: {text}",
                    "type": "alpha"
                },
                {
                    "text": "biopsy (detail)",
                    "template": "biopsy: {text}",
                    "type": "alpha"
                },
                {
                    "text": "laser treatment (detail)",
                    "template": "laser treatment: {text}",
                    "type": "alpha"
                },
                {
                    "text": "cryotherapy (detail)",
                    "template": "cryotherapy:",
                    "type": "alpha"
                },
                {
                    "text": "other comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "overweight\/obesity",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "overweight",
                            "template": "overweight",
                            "type": "plus-minus"
                        },
                        {
                            "text": "obese",
                            "template": "obese",
                            "type": "plus-minus"
                        },
                        {
                            "text": "morbid obesity",
                            "template": "morbid obesity",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "obesity contributing factors (describe)",
                    "template": "obesity contributing factors {text}",
                    "type": "alpha"
                },
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "coronary artery disease",
                    "template": "coronary artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "DVT",
                    "template": "DVT",
                    "type": "plus-minus"
                },
                {
                    "text": "hyperlipidemia",
                    "template": "hyperlipidemia",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes type 1",
                    "template": "diabetes type 1",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes type 2",
                    "template": "diabetes type 2",
                    "type": "plus-minus"
                },
                {
                    "text": "hypothyroidism",
                    "template": "hypothyroidism",
                    "type": "plus-minus"
                },
                {
                    "text": "liver disease",
                    "template": "liver disease",
                    "type": "plus-minus"
                },
                {
                    "text": "kidney disease",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "CKD stage 1",
                            "template": "CKD stage 1",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 2 (mild)",
                            "template": "CKD stage 2 (mild)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 3 (moderate)",
                            "template": "CKD stage 3 (moderate)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 4 (severe)",
                            "template": "CKD stage 4 (severe)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "ESRD",
                            "template": "End Stage Renal Disease",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "immunosuppression",
                    "template": "immunosuppression",
                    "type": "plus-minus"
                },
                {
                    "text": "hx oligomenorrhea",
                    "template": "hx oligomenorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "hx infection",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "chlamydia",
                            "template": "chlamydia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "gonorrhea",
                            "template": "gonorrhea",
                            "type": "plus-minus"
                        },
                        {
                            "text": "genital herpes",
                            "template": "genital herpes",
                            "type": "plus-minus"
                        },
                        {
                            "text": "HIV",
                            "template": "HIV",
                            "type": "plus-minus"
                        },
                        {
                            "text": "HPV",
                            "template": "HPV",
                            "type": "plus-minus"
                        },
                        {
                            "text": "syphilis",
                            "template": "syphilis",
                            "type": "plus-minus"
                        },
                        {
                            "text": "trichomonas",
                            "template": "trichomonas",
                            "type": "plus-minus"
                        },
                        {
                            "text": "hx bacterial vaginosis",
                            "template": "hx bacterial vaginosis",
                            "type": "plus-minus"
                        },
                        {
                            "text": "hx STD",
                            "template": "hx STD",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "HPV vaccine",
                    "template": "HPV vaccine",
                    "type": "plus-minus"
                },
                {
                    "text": "hx abnormal PAP",
                    "template": "hx abnormal PAP",
                    "type": "plus-minus"
                },
                {
                    "text": "hx infertility",
                    "template": "hx infertility",
                    "type": "plus-minus"
                },
                {
                    "text": "chronic cervicitis",
                    "template": "chronic cervicitis",
                    "type": "plus-minus"
                },
                {
                    "text": "exposure to DES",
                    "template": "exposure to DES",
                    "type": "plus-minus"
                },
                {
                    "text": "cervical cancer",
                    "template": "cervical cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "uterine cancer",
                    "template": "uterine cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "vaginal cancer",
                    "template": "vaginal cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "vulvar cancer",
                    "template": "vulvar cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "ovarian cancer",
                    "template": "ovarian cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "cancer history (describe)",
                    "template": "(+) cancer, {text}",
                    "type": "alpha"
                },
                {
                    "text": "hx surgery (describe)",
                    "template": "(+) hx surgery: {text}",
                    "type": "alpha"
                },
                {
                    "text": "other medical Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environment factors",
            "template": "Lifestyle\/Environment factors include {children}.",
            "children": [
                {
                    "text": "alcohol use >1 drink\/day",
                    "template": "alcohol use >1 drink\/day",
                    "type": "plus-minus"
                },
                {
                    "text": "alcohol, amount\/frequency\/duration",
                    "template": "alcohol use is {text}",
                    "type": "alpha"
                },
                {
                    "text": "illicit drug use",
                    "template": "illicit drug use",
                    "type": "plus-minus"
                },
                {
                    "text": "illicit drug use, type\/frequency\/duration",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "high fat diet",
                    "template": "high fat diet",
                    "type": "plus-minus"
                },
                {
                    "text": "regular exercise",
                    "template": "regular exercise",
                    "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"
                }
            ]
        },
        {
            "text": "Family Hx specific to visit",
            "template": "Family history includes {children}.",
            "children": [
                {
                    "text": "cardiovascular disease",
                    "template": "cardiovascular disease",
                    "type": "plus-minus"
                },
                {
                    "text": "stroke",
                    "template": "stroke",
                    "type": "plus-minus"
                },
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "hypercholesterolemia",
                    "template": "hypercholesterolemia",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes",
                    "template": "diabetes",
                    "type": "plus-minus"
                },
                {
                    "text": "osteoporosis",
                    "template": "osteoporosis",
                    "type": "plus-minus"
                },
                {
                    "text": "breast cancer immediate relatives",
                    "template": "breast cancer in immediate relatives",
                    "type": "plus-minus"
                },
                {
                    "text": "colon cancer",
                    "template": "colon cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "ovarian cancer",
                    "template": "ovarian cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "other family Hx (describe)",
                    "template": "family Hx {text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}