{
    "section": "subjective",
    "templateSet": "Chest Pain (Prose Subjective)",
    "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 chest pain",
                    "template": "initial evaluation of chest pain"
                },
                {
                    "text": "follow-up chest pain evaluation",
                    "template": "follow-up chest pain evaluation"
                },
                {
                    "text": "ongoing chest pain management",
                    "template": "ongoing chest pain management"
                },
                {
                    "text": "Visit reason (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Duration",
            "template": "Symptom duration is estimated to be {children}.",
            "children": [
                {
                    "text": "Duration (minutes)",
                    "template": "{text} minutes",
                    "type": "number"
                },
                {
                    "text": "Duration (hours)",
                    "template": "{text} hours",
                    "type": "number"
                },
                {
                    "text": "Duration (days)",
                    "template": "{text} days",
                    "type": "number"
                },
                {
                    "text": "Duration (weeks)",
                    "template": "{text} weeks",
                    "type": "number"
                },
                {
                    "text": "Duration (months)",
                    "template": "{text} months",
                    "type": "number"
                },
                {
                    "text": "Duration (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Type\/Quality",
            "template": "The patient complains of a {children} sensation in the chest.",
            "children": [
                {
                    "text": "pain",
                    "template": "pain"
                },
                {
                    "text": "pressure",
                    "template": "pressure"
                },
                {
                    "text": "heaviness",
                    "template": "heaviness"
                },
                {
                    "text": "crushing",
                    "template": "crushing"
                },
                {
                    "text": "squeezing",
                    "template": "squeezing"
                },
                {
                    "text": "constricting",
                    "template": "constricting"
                },
                {
                    "text": "fullness",
                    "template": "fullness"
                },
                {
                    "text": "dullness",
                    "template": "dullness"
                },
                {
                    "text": "aching",
                    "template": "aching"
                },
                {
                    "text": "poorly-defined discomfort",
                    "template": "poorly-defined discomfort"
                },
                {
                    "text": "stabbing",
                    "template": "stabbing"
                },
                {
                    "text": "sharp pain",
                    "template": "sharp pain"
                },
                {
                    "text": "shooting",
                    "template": "shooting"
                },
                {
                    "text": "tearing",
                    "template": "tearing"
                },
                {
                    "text": "burning",
                    "template": "burning"
                },
                {
                    "text": "spasm",
                    "template": "spasm"
                },
                {
                    "text": "chest pain type\/quality (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Severity",
            "template": "Severity is reported to be {children}.",
            "children": [
                {
                    "text": "severity scale (0-10)",
                    "template": "{text} out of 10 maximally",
                    "type": "number"
                },
                {
                    "text": "minimal",
                    "template": "minimal"
                },
                {
                    "text": "mild",
                    "template": "mild"
                },
                {
                    "text": "moderate",
                    "template": "moderate"
                },
                {
                    "text": "severe",
                    "template": "severe"
                },
                {
                    "text": "intense",
                    "template": "intense"
                },
                {
                    "text": "unbearable",
                    "template": "unbearable"
                },
                {
                    "text": "variable in intensity",
                    "template": "variable in intensity"
                },
                {
                    "text": "unassessable",
                    "template": "unassessable"
                },
                {
                    "text": "chest pain severity (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Location",
            "template": "The sensation was {children}.",
            "children": [
                {
                    "text": "nonlocalizable",
                    "template": "not localizable"
                },
                {
                    "text": "anterior chest primary location",
                    "template": "localized primarily to the {children} chest area",
                    "children": [
                        {
                            "text": "substernal",
                            "template": "substernal"
                        },
                        {
                            "text": "center of chest",
                            "template": "central anterior"
                        },
                        {
                            "text": "upper anterior chest",
                            "template": "upper anterior"
                        },
                        {
                            "text": "middle anterior chest",
                            "template": "middle anterior"
                        },
                        {
                            "text": "entire anterior chest",
                            "template": "entire anterior"
                        },
                        {
                            "text": "R anterior chest",
                            "template": "right anterior"
                        },
                        {
                            "text": "L anterior chest",
                            "template": "left anterior"
                        },
                        {
                            "text": "R upper chest",
                            "template": "right upper anterior"
                        },
                        {
                            "text": "L upper chest",
                            "template": "left upper anterior"
                        },
                        {
                            "text": "R lateral chest",
                            "template": "right lateral anterior"
                        },
                        {
                            "text": "L lateral chest",
                            "template": "left lateral anterior"
                        },
                        {
                            "text": "R lower chest",
                            "template": "right lower anterior"
                        },
                        {
                            "text": "L lower chest",
                            "template": "left lower anterior"
                        }
                    ]
                },
                {
                    "text": "diffuse throughout the chest",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "diffuse throughout the chest",
                            "template": "diffuse throughout the chest"
                        },
                        {
                            "text": "band-like around the chest",
                            "template": "described as a band around the chest"
                        },
                        {
                            "text": "throughout the entire thorax",
                            "template": "felt throughout the entire thorax"
                        },
                        {
                            "text": "multiple locations throughout chest",
                            "template": "in multiple locations throughout the chest"
                        }
                    ]
                },
                {
                    "text": "lateral thorax primary location",
                    "template": "localized primarily to the {children} chest area",
                    "children": [
                        {
                            "text": "R lateral chest",
                            "template": "right lateral"
                        },
                        {
                            "text": "L lateral chest",
                            "template": "left lateral chest"
                        },
                        {
                            "text": "R axillary area",
                            "template": "right axillary area"
                        },
                        {
                            "text": "L axillary area",
                            "template": "left axillary area"
                        },
                        {
                            "text": "R middle lateral chest",
                            "template": "right middle lateral"
                        },
                        {
                            "text": "L middle lateral chest",
                            "template": "left middle lateral"
                        },
                        {
                            "text": "R lower lateral chest",
                            "template": "right lower lateral"
                        },
                        {
                            "text": "L lower lateral chest",
                            "template": "left lower lateral"
                        }
                    ]
                },
                {
                    "text": "posterior chest primary location",
                    "template": "localized primarily to the {children} chest area",
                    "children": [
                        {
                            "text": "center back of chest",
                            "template": "center posterior"
                        },
                        {
                            "text": "middle back of chest",
                            "template": "middle posterior"
                        },
                        {
                            "text": "upper back of chest",
                            "template": "upper posterior"
                        },
                        {
                            "text": "entire posterior chest",
                            "template": "entire posterior"
                        },
                        {
                            "text": "R posterior chest",
                            "template": "right posterior"
                        },
                        {
                            "text": "L posterior chest",
                            "template": "left posterior"
                        },
                        {
                            "text": "R upper back of chest",
                            "template": "right upper posterior"
                        },
                        {
                            "text": "L upper back of chest",
                            "template": "left upper posterior"
                        },
                        {
                            "text": "R lateral back of chest",
                            "template": "right lateral posterior"
                        },
                        {
                            "text": "L lateral back of chest",
                            "template": "left lateral anterior"
                        },
                        {
                            "text": "R lower back of chest",
                            "template": "right lower posterior"
                        },
                        {
                            "text": "L lower back of chest",
                            "template": "left lower posterior"
                        },
                        {
                            "text": "spine",
                            "template": "posterior spinal"
                        }
                    ]
                },
                {
                    "text": "epigastrium primary location",
                    "template": "localized primarily to the {children}",
                    "children": [
                        {
                            "text": "epigastrium",
                            "template": "epigastrium"
                        },
                        {
                            "text": "subxiphoid area",
                            "template": "subxiphoid area"
                        },
                        {
                            "text": "midepigastrium",
                            "template": "midepigastrium"
                        },
                        {
                            "text": "entire epigastrium anteriorly",
                            "template": "entire epigastrium anteriorly"
                        },
                        {
                            "text": "RUQ",
                            "template": "right upper quadrant area"
                        },
                        {
                            "text": "LUQ",
                            "template": "left upper quadrant area"
                        }
                    ]
                },
                {
                    "text": "supraclavicular area",
                    "template": "localized primarily to the {children}",
                    "children": [
                        {
                            "text": "right supraclavicular area anteriorly",
                            "template": "right supraclavicular area anteriorly"
                        },
                        {
                            "text": "left supraclavicular area anteriorly",
                            "template": "left supraclavicular area anteriorly"
                        },
                        {
                            "text": "right supraclavicular area posteriorly",
                            "template": "right supraclavicular area posteriorly"
                        },
                        {
                            "text": "left supraclavicular area posteriorly",
                            "template": "left supraclavicular area posteriorly"
                        },
                        {
                            "text": "right chest superiorly",
                            "template": "right chest superiorly"
                        },
                        {
                            "text": "left chest superiorly",
                            "template": "left chest superiorly"
                        },
                        {
                            "text": "superior chest bilaterally",
                            "template": "superior chest bilaterally"
                        }
                    ]
                },
                {
                    "text": "R flank area",
                    "template": "localized primarily to the right flank"
                },
                {
                    "text": "L flank area",
                    "template": "localized primarily to the left flank"
                },
                {
                    "text": "chest pain location (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Radiation",
            "template": "Radiation {children}.",
            "children": [
                {
                    "text": "no radiation",
                    "template": "was not noted"
                },
                {
                    "text": "radiation locations",
                    "template": "was noted to the {children}",
                    "children": [
                        {
                            "text": "R chest",
                            "template": "right chest"
                        },
                        {
                            "text": "L chest",
                            "template": "left chest"
                        },
                        {
                            "text": "R arm",
                            "template": "right arm"
                        },
                        {
                            "text": "L arm",
                            "template": "left arm"
                        },
                        {
                            "text": "R shoulder",
                            "template": "right shoulder"
                        },
                        {
                            "text": "L shoulder",
                            "template": "left shoulder"
                        },
                        {
                            "text": "R scapula",
                            "template": "right scapula"
                        },
                        {
                            "text": "L scapula",
                            "template": "left scapula"
                        },
                        {
                            "text": "neck",
                            "template": "neck"
                        },
                        {
                            "text": "jaw",
                            "template": "jaw"
                        },
                        {
                            "text": "throat area",
                            "template": "throat area"
                        },
                        {
                            "text": "epigastrium",
                            "template": "epigastrium"
                        },
                        {
                            "text": "abdomen",
                            "template": "abdomen"
                        },
                        {
                            "text": "back",
                            "template": "back"
                        },
                        {
                            "text": "R flank",
                            "template": "right flank area"
                        },
                        {
                            "text": "L flank",
                            "template": "left flank area"
                        },
                        {
                            "text": "area along the rib",
                            "template": "area along the rib"
                        },
                        {
                            "text": "groin",
                            "template": "groin area"
                        }
                    ]
                },
                {
                    "text": "chest pain radiation (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Onset",
            "template": "Onset of symptoms {children}.",
            "children": [
                {
                    "text": "nature of onset",
                    "template": "was {children} in nature",
                    "children": [
                        {
                            "text": "sudden",
                            "template": "sudden"
                        },
                        {
                            "text": "acute",
                            "template": "acute"
                        },
                        {
                            "text": "gradual",
                            "template": "gradual"
                        },
                        {
                            "text": "insidious",
                            "template": "insidious"
                        },
                        {
                            "text": "traumatic",
                            "template": "traumatic"
                        },
                        {
                            "text": "stuttering",
                            "template": "stuttering"
                        }
                    ]
                },
                {
                    "text": "activities vs. rest at onset",
                    "template": "occurred {children}",
                    "children": [
                        {
                            "text": "during vigorous exercise",
                            "template": "during vigorous exercise"
                        },
                        {
                            "text": "during athletic activity",
                            "template": "during athletic activity"
                        },
                        {
                            "text": "during moderate physical activity",
                            "template": "during moderate physical activity"
                        },
                        {
                            "text": "during exertion",
                            "template": "during exertion"
                        },
                        {
                            "text": "following exertion",
                            "template": "following exertion"
                        },
                        {
                            "text": "during exercise",
                            "template": "during exercise"
                        },
                        {
                            "text": "during sexual activity",
                            "template": "during sexual activity"
                        },
                        {
                            "text": "during minimal exertion",
                            "template": "during minimal exertion"
                        },
                        {
                            "text": "under stressful circumstances",
                            "template": "under stressful circumstances"
                        },
                        {
                            "text": "during arguing",
                            "template": "during arguing"
                        },
                        {
                            "text": "while eating",
                            "template": "while eating"
                        },
                        {
                            "text": "after a meal",
                            "template": "after a meal"
                        },
                        {
                            "text": "while resting after exertion",
                            "template": "while resting after exertion"
                        },
                        {
                            "text": "while at rest",
                            "template": "while at rest"
                        },
                        {
                            "text": "during sleep",
                            "template": "during sleep"
                        },
                        {
                            "text": "during an injury",
                            "template": "during an injury"
                        }
                    ]
                },
                {
                    "text": "onset date\/time (specify)",
                    "template": "began {text}",
                    "type": "alpha"
                },
                {
                    "text": "onset (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Course\/ Progression",
            "template": "Symptoms {children}.",
            "children": [
                {
                    "text": "symptom course after onset",
                    "template": "{children} over time",
                    "children": [
                        {
                            "text": "progressively improved",
                            "template": "progressively improved"
                        },
                        {
                            "text": "worsened then improved",
                            "template": "worsened then improved"
                        },
                        {
                            "text": "became intermittent",
                            "template": "became intermittent"
                        },
                        {
                            "text": "were variable",
                            "template": "were variable"
                        },
                        {
                            "text": "waxed and waned",
                            "template": "waxed and waned"
                        },
                        {
                            "text": "improved and then worsened",
                            "template": "improved and then worsened"
                        },
                        {
                            "text": "remained constant",
                            "template": "remained constant"
                        },
                        {
                            "text": "progressively worsened",
                            "template": "progressively worsened"
                        },
                        {
                            "text": "escalated significantly",
                            "template": "escalated significantly"
                        }
                    ]
                },
                {
                    "text": "status of current symptoms",
                    "template": "are currently {children}",
                    "children": [
                        {
                            "text": "completely resolved",
                            "template": "completely resolved"
                        },
                        {
                            "text": "nearly resolved",
                            "template": "nearly resolved"
                        },
                        {
                            "text": "much improved",
                            "template": "much improved"
                        },
                        {
                            "text": "somewhat improved",
                            "template": "somewhat improved"
                        },
                        {
                            "text": "stable in severity",
                            "template": "stable in severity"
                        },
                        {
                            "text": "somewhat worse",
                            "template": "somewhat worse"
                        },
                        {
                            "text": "significantly worse",
                            "template": "significantly worse"
                        },
                        {
                            "text": "at maximal severity",
                            "template": "at maximal severity"
                        }
                    ]
                },
                {
                    "text": "current sx severity (0 -10) (specify)",
                    "template": "are currently at {text} out of 10 in severity",
                    "type": "number"
                },
                {
                    "text": "sx course details (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Provocation",
            "template": "Worsening of symptoms was {children}.",
            "children": [
                {
                    "text": "no provoking factors noted",
                    "template": "not associated with any provoking factors"
                },
                {
                    "text": "provoking factors",
                    "template": "provoked by {children}",
                    "children": [
                        {
                            "text": "stress",
                            "template": "stress"
                        },
                        {
                            "text": "exertion",
                            "template": "exertion"
                        },
                        {
                            "text": "speaking",
                            "template": "speaking"
                        },
                        {
                            "text": "lying flat",
                            "template": "lying flat"
                        },
                        {
                            "text": "eating",
                            "template": "eating"
                        },
                        {
                            "text": "drinking",
                            "template": "drinking"
                        },
                        {
                            "text": "swallowing",
                            "template": "swallowing"
                        },
                        {
                            "text": "belching",
                            "template": "belching"
                        },
                        {
                            "text": "deep breathing",
                            "template": "deep breathing"
                        },
                        {
                            "text": "coughing",
                            "template": "coughing"
                        },
                        {
                            "text": "movement",
                            "template": "movement"
                        },
                        {
                            "text": "twisting upper body",
                            "template": "twisting upper body"
                        },
                        {
                            "text": "arching upper back",
                            "template": "arching upper back"
                        },
                        {
                            "text": "leaning forward",
                            "template": "leaning forward"
                        },
                        {
                            "text": "moving arms",
                            "template": "moving arms"
                        },
                        {
                            "text": "rest",
                            "template": "rest"
                        },
                        {
                            "text": "weather changes",
                            "template": "weather changes"
                        },
                        {
                            "text": "touch to the chest",
                            "template": "touch to the chest"
                        }
                    ]
                },
                {
                    "text": "more provoking factors (specify)",
                    "template": "provoked by {text}",
                    "type": "alpha"
                },
                {
                    "text": "nonprovoking factors",
                    "template": "not provoked by {children}",
                    "children": [
                        {
                            "text": "stress",
                            "template": "stress"
                        },
                        {
                            "text": "exertion",
                            "template": "exertion"
                        },
                        {
                            "text": "speaking",
                            "template": "speaking"
                        },
                        {
                            "text": "lying flat",
                            "template": "lying flat"
                        },
                        {
                            "text": "eating",
                            "template": "eating"
                        },
                        {
                            "text": "drinking",
                            "template": "drinking"
                        },
                        {
                            "text": "swallowing",
                            "template": "swallowing"
                        },
                        {
                            "text": "deep breathing",
                            "template": "deep breathing"
                        },
                        {
                            "text": "belching",
                            "template": "belching"
                        },
                        {
                            "text": "coughing",
                            "template": "coughing"
                        },
                        {
                            "text": "movement",
                            "template": "movement"
                        },
                        {
                            "text": "twisting upper body",
                            "template": "twisting upper body"
                        },
                        {
                            "text": "arching upper back",
                            "template": "arching upper back"
                        },
                        {
                            "text": "leaning forward",
                            "template": "leaning forward"
                        },
                        {
                            "text": "moving arms",
                            "template": "moving arms"
                        },
                        {
                            "text": "rest",
                            "template": "rest"
                        },
                        {
                            "text": "weather changes",
                            "template": "weather changes"
                        },
                        {
                            "text": "touch to the chest",
                            "template": "touch to the chest"
                        }
                    ]
                },
                {
                    "text": "more nonprovoking factors (specify)",
                    "template": "not provoked by {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Palliation",
            "template": "Alleviation of symptoms was {children}.",
            "children": [
                {
                    "text": "no alleviating factors noted",
                    "template": "not associated with any relieving factors"
                },
                {
                    "text": "alleviating factors",
                    "template": "promoted by {children}",
                    "children": [
                        {
                            "text": "rest",
                            "template": "rest"
                        },
                        {
                            "text": "nitroglycerin",
                            "template": "nitroglycerin"
                        },
                        {
                            "text": "antianginal medication",
                            "template": "antianginal medication"
                        },
                        {
                            "text": "antacid medication",
                            "template": "antacid medication"
                        },
                        {
                            "text": "sitting upright",
                            "template": "sitting upright"
                        },
                        {
                            "text": "leaning forward",
                            "template": "leaning forward"
                        },
                        {
                            "text": "belching",
                            "template": "belching"
                        },
                        {
                            "text": "eating",
                            "template": "eating"
                        },
                        {
                            "text": "drinking",
                            "template": "drinking"
                        },
                        {
                            "text": "swallowing",
                            "template": "swallowing"
                        },
                        {
                            "text": "deep breathing",
                            "template": "deep breathing"
                        },
                        {
                            "text": "coughing",
                            "template": "coughing"
                        },
                        {
                            "text": "movement",
                            "template": "movement"
                        },
                        {
                            "text": "twisting upper body",
                            "template": "twisting upper body"
                        },
                        {
                            "text": "arching upper back",
                            "template": "arching upper back"
                        },
                        {
                            "text": "moving arms",
                            "template": "moving arms"
                        },
                        {
                            "text": "lying flat",
                            "template": "lying flat"
                        },
                        {
                            "text": "relaxation",
                            "template": "relaxation"
                        },
                        {
                            "text": "touch to the chest",
                            "template": "touch to the chest"
                        },
                        {
                            "text": "weather changes",
                            "template": "weather changes"
                        },
                        {
                            "text": "exertion",
                            "template": "exertion"
                        }
                    ]
                },
                {
                    "text": "other alleviators (describe)",
                    "template": "promoted by {text}",
                    "type": "alpha"
                },
                {
                    "text": "non-alleviating factors",
                    "template": "not promoted by {children}",
                    "children": [
                        {
                            "text": "rest",
                            "template": "rest"
                        },
                        {
                            "text": "nitroglycerin",
                            "template": "nitroglycerin"
                        },
                        {
                            "text": "antianginal medication",
                            "template": "antianginal medication"
                        },
                        {
                            "text": "antacid medication",
                            "template": "antacid medication"
                        },
                        {
                            "text": "sitting upright",
                            "template": "sitting upright"
                        },
                        {
                            "text": "leaning forward",
                            "template": "leaning forward"
                        },
                        {
                            "text": "belching",
                            "template": "belching"
                        },
                        {
                            "text": "eating",
                            "template": "eating"
                        },
                        {
                            "text": "drinking",
                            "template": "drinking"
                        },
                        {
                            "text": "swallowing",
                            "template": "swallowing"
                        },
                        {
                            "text": "deep breathing",
                            "template": "deep breathing"
                        },
                        {
                            "text": "coughing",
                            "template": "coughing"
                        },
                        {
                            "text": "movement",
                            "template": "movement"
                        },
                        {
                            "text": "twisting upper body",
                            "template": "twisting upper body"
                        },
                        {
                            "text": "arching upper back",
                            "template": "arching upper back"
                        },
                        {
                            "text": "moving arms",
                            "template": "moving arms"
                        },
                        {
                            "text": "lying flat",
                            "template": "lying flat"
                        },
                        {
                            "text": "relaxation",
                            "template": "relaxation"
                        },
                        {
                            "text": "touch to the chest",
                            "template": "touch to the chest"
                        },
                        {
                            "text": "weather changes",
                            "template": "weather changes"
                        },
                        {
                            "text": "exertion",
                            "template": "exertion"
                        }
                    ]
                },
                {
                    "text": "other nonalleviators (specify)",
                    "template": "not promoted by {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent negative symptoms",
            "template": "The patient denies {children}.",
            "children": [
                {
                    "text": "no dyspnea",
                    "template": "dyspnea"
                },
                {
                    "text": "no diaphoresis",
                    "template": "diaphoresis"
                },
                {
                    "text": "no lightheadedness",
                    "template": "lightheadedness"
                },
                {
                    "text": "no nausea",
                    "template": "nausea"
                },
                {
                    "text": "no vomiting",
                    "template": "vomiting"
                },
                {
                    "text": "no cough",
                    "template": "cough"
                },
                {
                    "text": "no fever",
                    "template": "fever"
                },
                {
                    "text": "no dyspnea sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "shortness of breath",
                            "template": "shortness of breath"
                        },
                        {
                            "text": "dyspnea on exertion",
                            "template": "dyspnea on exertion"
                        },
                        {
                            "text": "dyspnea at rest",
                            "template": "dyspnea at rest"
                        },
                        {
                            "text": "orthopnea",
                            "template": "orthopnea"
                        },
                        {
                            "text": "paroxysmal nocturnal dyspnea",
                            "template": "paroxysmal nocturnal dyspnea"
                        },
                        {
                            "text": "platypnea",
                            "template": "platypnea"
                        },
                        {
                            "text": "wheezing",
                            "template": "wheezing"
                        }
                    ]
                },
                {
                    "text": "no constitutional sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "diaphoresis",
                            "template": "diaphoresis"
                        },
                        {
                            "text": "lightheadedness",
                            "template": "lightheadedness"
                        },
                        {
                            "text": "syncope",
                            "template": "syncope"
                        },
                        {
                            "text": "dizziness",
                            "template": "dizziness"
                        },
                        {
                            "text": "palpitations",
                            "template": "palpitations"
                        },
                        {
                            "text": "fatigue",
                            "template": "fatigue"
                        },
                        {
                            "text": "decreased exercise tolerance",
                            "template": "decreased exercise tolerance"
                        },
                        {
                            "text": "weakness",
                            "template": "weakness"
                        },
                        {
                            "text": "hiccups",
                            "template": "hiccups"
                        },
                        {
                            "text": "fever",
                            "template": "fever"
                        },
                        {
                            "text": "chills",
                            "template": "chills"
                        },
                        {
                            "text": "recent immobilization",
                            "template": "recent immobilization"
                        },
                        {
                            "text": "anorexia",
                            "template": "anorexia"
                        },
                        {
                            "text": "recent weight loss",
                            "template": "recent weight loss"
                        },
                        {
                            "text": "recent weight gain",
                            "template": "recent weight gain"
                        }
                    ]
                },
                {
                    "text": "no cough\/ URI sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "cough",
                            "template": "cough"
                        },
                        {
                            "text": "dry cough",
                            "template": "dry cough"
                        },
                        {
                            "text": "cough productive of sputum",
                            "template": "cough productive of sputum"
                        },
                        {
                            "text": "blood-tinged sputum",
                            "template": "blood-tinged sputum"
                        },
                        {
                            "text": "sore throat",
                            "template": "sore throat"
                        },
                        {
                            "text": "nasal congestion",
                            "template": "nasal congestion"
                        },
                        {
                            "text": "conjunctival symptoms",
                            "template": "conjunctival symptoms"
                        },
                        {
                            "text": "hoarse voice",
                            "template": "hoarse voice"
                        },
                        {
                            "text": "swollen glands",
                            "template": "swollen glands"
                        },
                        {
                            "text": "wheezing",
                            "template": "wheezing"
                        }
                    ]
                },
                {
                    "text": "no GI sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea"
                        },
                        {
                            "text": "vomiting",
                            "template": "vomiting"
                        },
                        {
                            "text": "constipation",
                            "template": "constipation"
                        },
                        {
                            "text": "reflux",
                            "template": "reflux"
                        },
                        {
                            "text": "dysphagia",
                            "template": "dysphagia"
                        },
                        {
                            "text": "belching",
                            "template": "belching"
                        },
                        {
                            "text": "burping",
                            "template": "burping"
                        }
                    ]
                },
                {
                    "text": "no extremity sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "back pain",
                            "template": "back pain"
                        },
                        {
                            "text": "myalgias",
                            "template": "myalgias"
                        },
                        {
                            "text": "leg pain",
                            "template": "leg pain"
                        },
                        {
                            "text": "joint pain",
                            "template": "joint pain"
                        },
                        {
                            "text": "lower extremity edema",
                            "template": "lower extremity edema"
                        },
                        {
                            "text": "arm weakness",
                            "template": "arm weakness"
                        },
                        {
                            "text": "upper extremity sensory changes",
                            "template": "upper extremity sensory changes"
                        }
                    ]
                },
                {
                    "text": "no neurologic sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "dysarthria",
                            "template": "dysarthria"
                        },
                        {
                            "text": "upper extremity weakness",
                            "template": "upper extremity weakness"
                        },
                        {
                            "text": "upper extremity numbness",
                            "template": "upper extremity numbness"
                        },
                        {
                            "text": "upper extremity paresthesias",
                            "template": "upper extremity paresthesias"
                        }
                    ]
                },
                {
                    "text": "no urologic, flank sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "right flank pain",
                            "template": "right flank pain"
                        },
                        {
                            "text": "left flank pain",
                            "template": "left flank pain"
                        },
                        {
                            "text": "dysuria",
                            "template": "dysuria"
                        },
                        {
                            "text": "hematuria",
                            "template": "hematuria"
                        },
                        {
                            "text": "cloudy urine",
                            "template": "cloudy urine"
                        },
                        {
                            "text": "foul smelling urine",
                            "template": "foul smelling urine"
                        }
                    ]
                },
                {
                    "text": "no dermatologic sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "diaphoresis",
                            "template": "diaphoresis"
                        },
                        {
                            "text": "rash on chest",
                            "template": "rash on chest"
                        },
                        {
                            "text": "shingles outbreak",
                            "template": "shingles outbreak"
                        },
                        {
                            "text": "axillary mass",
                            "template": "axillary mass"
                        },
                        {
                            "text": "cervical lymphadenopathy",
                            "template": "cervical lymphadenopathy"
                        },
                        {
                            "text": "cyanosis",
                            "template": "cyanosis"
                        }
                    ]
                },
                {
                    "text": "no psychiatric sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "worrying",
                            "template": "worrying"
                        },
                        {
                            "text": "anxiety",
                            "template": "anxiety"
                        }
                    ]
                },
                {
                    "text": "other negative sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positive symptoms",
            "template": "Reported symptoms include {children}.",
            "children": [
                {
                    "text": "Shortness of breath",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "shortness of breath",
                            "template": "shortness of breath"
                        },
                        {
                            "text": "dyspnea on exertion",
                            "template": "dyspnea on exertion"
                        },
                        {
                            "text": "dyspnea at rest",
                            "template": "dyspnea at rest"
                        },
                        {
                            "text": "orthopnea",
                            "template": "orthopnea"
                        },
                        {
                            "text": "paroxysmal nocturnal dyspnea",
                            "template": "paroxysmal nocturnal dyspnea"
                        },
                        {
                            "text": "platypnea",
                            "template": "platypnea"
                        },
                        {
                            "text": "wheezing",
                            "template": "wheezing"
                        }
                    ]
                },
                {
                    "text": "General\/Constitutional sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "diaphoresis",
                            "template": "diaphoresis"
                        },
                        {
                            "text": "lightheadedness",
                            "template": "lightheadedness"
                        },
                        {
                            "text": "syncope",
                            "template": "syncope"
                        },
                        {
                            "text": "dizziness",
                            "template": "dizziness"
                        },
                        {
                            "text": "palpitations",
                            "template": "palpitations"
                        },
                        {
                            "text": "fatigue",
                            "template": "fatigue"
                        },
                        {
                            "text": "decreased exercise tolerance",
                            "template": "decreased exercise tolerance"
                        },
                        {
                            "text": "weakness",
                            "template": "weakness"
                        },
                        {
                            "text": "hiccups",
                            "template": "hiccups"
                        },
                        {
                            "text": "fever",
                            "template": "fever"
                        },
                        {
                            "text": "chills",
                            "template": "chills"
                        },
                        {
                            "text": "recent immobilization",
                            "template": "recent immobilization"
                        },
                        {
                            "text": "anorexia",
                            "template": "anorexia"
                        },
                        {
                            "text": "recent weight loss",
                            "template": "recent weight loss"
                        },
                        {
                            "text": "recent weight gain",
                            "template": "recent weight gain"
                        }
                    ]
                },
                {
                    "text": "Cough\/URI symptoms",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "cough",
                            "template": "cough"
                        },
                        {
                            "text": "dry cough",
                            "template": "dry cough"
                        },
                        {
                            "text": "cough productive of sputum",
                            "template": "cough productive of sputum"
                        },
                        {
                            "text": "blood-tinged sputum",
                            "template": "blood-tinged sputum"
                        },
                        {
                            "text": "sore throat",
                            "template": "sore throat"
                        },
                        {
                            "text": "nasal congestion",
                            "template": "nasal congestion"
                        },
                        {
                            "text": "conjunctival symptoms",
                            "template": "conjunctival symptoms"
                        },
                        {
                            "text": "hoarse voice",
                            "template": "hoarse voice"
                        },
                        {
                            "text": "swollen glands",
                            "template": "swollen glands"
                        },
                        {
                            "text": "wheezing",
                            "template": "wheezing"
                        }
                    ]
                },
                {
                    "text": "GI sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea"
                        },
                        {
                            "text": "vomiting",
                            "template": "vomiting"
                        },
                        {
                            "text": "constipation",
                            "template": "constipation"
                        },
                        {
                            "text": "reflux",
                            "template": "reflux"
                        },
                        {
                            "text": "dysphagia",
                            "template": "dysphagia"
                        },
                        {
                            "text": "belching",
                            "template": "belching"
                        },
                        {
                            "text": "burping",
                            "template": "burping"
                        }
                    ]
                },
                {
                    "text": "Musculoskeletal, extremity sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "back pain",
                            "template": "back pain"
                        },
                        {
                            "text": "myalgias",
                            "template": "myalgias"
                        },
                        {
                            "text": "leg pain",
                            "template": "leg pain"
                        },
                        {
                            "text": "joint pain",
                            "template": "joint pain"
                        },
                        {
                            "text": "lower extremity edema",
                            "template": "lower extremity edema"
                        },
                        {
                            "text": "right arm weakness",
                            "template": "right arm weakness"
                        },
                        {
                            "text": "left arm weakness",
                            "template": "left arm weakness"
                        },
                        {
                            "text": "right arm sensory changes",
                            "template": "right arm sensory changes"
                        },
                        {
                            "text": "left arm sensory changes",
                            "template": "left arm sensory changes"
                        }
                    ]
                },
                {
                    "text": "Neurologic sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "dysarthria",
                            "template": "dysarthria"
                        },
                        {
                            "text": "right upper extremity weakness",
                            "template": "right upper extremity weakness"
                        },
                        {
                            "text": "left upper extremity weakness",
                            "template": "left upper extremity weakness"
                        },
                        {
                            "text": "right upper extremity numbness",
                            "template": "right upper extremity numbness"
                        },
                        {
                            "text": "left upper extremity numbness",
                            "template": "left upper extremity numbness"
                        },
                        {
                            "text": "right upper extremity paresthesias",
                            "template": "right upper extremity paresthesias"
                        },
                        {
                            "text": "left upper extremity paresthesias",
                            "template": "left upper extremity paresthesias"
                        }
                    ]
                },
                {
                    "text": "Urologic, flank sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "right flank pain",
                            "template": "right flank pain"
                        },
                        {
                            "text": "left flank pain",
                            "template": "left flank pain"
                        },
                        {
                            "text": "dysuria",
                            "template": "dysuria"
                        },
                        {
                            "text": "hematuria",
                            "template": "hematuria"
                        },
                        {
                            "text": "cloudy urine",
                            "template": "cloudy urine"
                        },
                        {
                            "text": "foul smelling urine",
                            "template": "foul smelling urine"
                        }
                    ]
                },
                {
                    "text": "Dermatologic sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "diaphoresis",
                            "template": "diaphoresis"
                        },
                        {
                            "text": "rash on chest",
                            "template": "rash on chest"
                        },
                        {
                            "text": "shingles outbreak",
                            "template": "shingles outbreak"
                        },
                        {
                            "text": "axillary mass",
                            "template": "axillary mass"
                        },
                        {
                            "text": "cervical lymphadenopathy",
                            "template": "cervical lymphadenopathy"
                        },
                        {
                            "text": "cyanosis",
                            "template": "cyanosis"
                        }
                    ]
                },
                {
                    "text": "Psychiatric sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "worrying",
                            "template": "worrying"
                        },
                        {
                            "text": "anxiety",
                            "template": "anxiety"
                        }
                    ]
                },
                {
                    "text": "T max (Fahrenheit)",
                    "template": "a maximal temperature of {text} degrees Fahrenheit",
                    "type": "number"
                },
                {
                    "text": "Other positive sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Tx response\/Side effects",
            "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": "no side effects noted",
                    "template": "no side effects noted"
                },
                {
                    "text": "common side effects",
                    "template": "side effects include {children}",
                    "children": [
                        {
                            "text": "headache",
                            "template": "headache",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dizziness\/LH",
                            "template": "dizziness or lightheadedness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "flushing",
                            "template": "flushing",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dyspepsia",
                            "template": "dyspepsia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea\/vomiting",
                            "template": "nausea\/vomiting",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding",
                            "template": "bleeding",
                            "type": "plus-minus"
                        },
                        {
                            "text": "easy bruising",
                            "template": "easy bruising",
                            "type": "plus-minus"
                        },
                        {
                            "text": "depression",
                            "template": "depression",
                            "type": "plus-minus"
                        },
                        {
                            "text": "shortness of breath",
                            "template": "shortness of breath",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cough",
                            "template": "cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "peripheral edema",
                            "template": "peripheral edema",
                            "type": "plus-minus"
                        },
                        {
                            "text": "rhinitis\/sinusitis",
                            "template": "rhinitis\/sinusitis",
                            "type": "plus-minus"
                        },
                        {
                            "text": "arthralgias",
                            "template": "arthralgias",
                            "type": "plus-minus"
                        },
                        {
                            "text": "muscle aches",
                            "template": "muscle aches",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "side effects (describe)",
                    "template": "side effects: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "coronary disease",
                    "template": "coronary artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "cardiovascular dz\/interventions",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "previous MI",
                            "template": "previous myocardial infarction"
                        },
                        {
                            "text": "CABG",
                            "template": "coronary artery bypass surgery"
                        },
                        {
                            "text": "coronary angioplasty",
                            "template": "coronary angioplasty"
                        },
                        {
                            "text": "coronary artery stenting",
                            "template": "coronary artery stenting"
                        },
                        {
                            "text": "coronary artery disease",
                            "template": "coronary artery disease"
                        },
                        {
                            "text": "angina",
                            "template": "angina"
                        },
                        {
                            "text": "previous stroke",
                            "template": "previous stroke"
                        },
                        {
                            "text": "previous TIA",
                            "template": "previous TIA"
                        },
                        {
                            "text": "arrhythmias",
                            "template": "arrhythmias"
                        },
                        {
                            "text": "known valvular disease",
                            "template": "known valvular disease"
                        },
                        {
                            "text": "valve surgery",
                            "template": "valve surgery"
                        },
                        {
                            "text": "venous thromboembolic disease",
                            "template": "venous thromboembolic disease"
                        },
                        {
                            "text": "DVT",
                            "template": "deep venous thrombosis"
                        },
                        {
                            "text": "pulmonary embolism",
                            "template": "pulmonary embolism"
                        },
                        {
                            "text": "carotid artery disease",
                            "template": "carotid artery disease"
                        },
                        {
                            "text": "AAA",
                            "template": "an abdominal aortic aneurysm"
                        },
                        {
                            "text": "known peripheral vascular disease",
                            "template": "known peripheral vascular disease"
                        },
                        {
                            "text": "peripheral artery bypass surgery",
                            "template": "peripheral artery bypass surgery"
                        }
                    ]
                },
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "hypercholesterolemia",
                    "template": "hypercholesterolemia",
                    "type": "plus-minus"
                },
                {
                    "text": "hypertriglyceridemia",
                    "template": "hypertriglyceridemia",
                    "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": "liver disease",
                    "template": "liver disease",
                    "type": "plus-minus"
                },
                {
                    "text": "dyslipidemia",
                    "template": "dyslipidemia",
                    "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": "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": "other medical Hx (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environment factors",
            "template": "Lifestyle\/Environment factors include {children}.",
            "children": [
                {
                    "text": "alcohol use",
                    "template": "alcohol use",
                    "type": "plus-minus"
                },
                {
                    "text": "alcohol abuse",
                    "template": "alcohol abuse",
                    "type": "plus-minus"
                },
                {
                    "text": "cocaine use",
                    "template": "cocaine use",
                    "type": "plus-minus"
                },
                {
                    "text": "methamphetamine use",
                    "template": "methamphetamine use",
                    "type": "plus-minus"
                },
                {
                    "text": "street drug use",
                    "template": "street drug use",
                    "type": "plus-minus"
                },
                {
                    "text": "high fat diet",
                    "template": "high fat diet",
                    "type": "plus-minus"
                },
                {
                    "text": "regular exercise",
                    "template": "regular exercise",
                    "type": "plus-minus"
                },
                {
                    "text": "sedentary lifestyle",
                    "template": "sedentary lifestyle",
                    "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"
                }
            ]
        }
    ]
}