{
    "section": "subjective",
    "templateSet": "Well Child Visit, 15 Months",
    "templates": [
        {
            "text": "(Patient age, months",
            "template": "Patient is a {text} month old",
            "type": "number"
        },
        {
            "text": "Sex",
            "template": "{children}",
            "children": [
                {
                    "text": "male",
                    "template": "male"
                },
                {
                    "text": "female",
                    "template": "female"
                }
            ]
        },
        {
            "text": "Reason for visit)",
            "template": "{children}.",
            "children": [
                {
                    "text": "well child visit\/no acute concerns",
                    "template": "brought in by caregiver for well child visit. Caregiver reports that the child is\n                                developing normally, and there are no acute concerns\n                            "
                },
                {
                    "text": "follow up from prior visit",
                    "template": "brought in by caregiver for follow up from prior visit"
                },
                {
                    "text": "follow up visit from hospital",
                    "template": "brought in by caregiver for follow up visit from hospital"
                },
                {
                    "text": "referred by hospital",
                    "template": "referred by hospital, accompanied by caregiver"
                },
                {
                    "text": "check up for travel",
                    "template": "brought in by caregiver for check up for travel"
                },
                {
                    "text": "well visit with acute concerns",
                    "template": "brought in by caregiver for well child visit. Caregiver reports concerns related to\n                                child, including {text}\n                            ",
                    "type": "alpha"
                },
                {
                    "text": "other well visit (describe)",
                    "template": "brought in by caregiver for {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Interval History",
            "template": "Patient's caregiver reports the presence\/absence of the following hx\/sx since the last visit:\n                        {children}.\n                    ",
            "children": [
                {
                    "text": "no complaints",
                    "template": "no complaints"
                },
                {
                    "text": "abdominal pain",
                    "template": "abdominal pain",
                    "type": "plus-minus"
                },
                {
                    "text": "congestion",
                    "template": "congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "ear pain",
                    "template": "ear pain",
                    "type": "plus-minus"
                },
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "sore throat",
                    "template": "sore throat",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "weight gain",
                    "template": "weight gain",
                    "type": "plus-minus"
                },
                {
                    "text": "weight loss",
                    "template": "weight loss",
                    "type": "plus-minus"
                },
                {
                    "text": "other history\/sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "congestion",
                    "template": "congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "crying",
                    "template": "crying",
                    "type": "plus-minus"
                },
                {
                    "text": "irritability",
                    "template": "irritability",
                    "type": "plus-minus"
                },
                {
                    "text": "lethargy",
                    "template": "lethargy",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal discharge",
                    "template": "nasal discharge",
                    "type": "plus-minus"
                },
                {
                    "text": "sneezing",
                    "template": "sneezing",
                    "type": "plus-minus"
                },
                {
                    "text": "rash",
                    "template": "rash",
                    "type": "plus-minus"
                },
                {
                    "text": "rhinorrhea",
                    "template": "rhinorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "other pertinent sx (describe)",
                    "template": "other symptoms: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Feeding",
            "template": "Feeding: {children}.",
            "children": [
                {
                    "text": "breastfeeding",
                    "template": "breastfeeding",
                    "type": "plus-minus"
                },
                {
                    "text": "weaning",
                    "template": "weaning",
                    "type": "plus-minus"
                },
                {
                    "text": "whole milk, amount daily (oz)",
                    "template": "{text} oz of whole milk per day",
                    "type": "alpha"
                },
                {
                    "text": "juice, amount daily (oz)",
                    "template": "{text}oz of milk per day",
                    "type": "alpha"
                },
                {
                    "text": "water, amount daily (oz)",
                    "template": "{text}oz of water per day",
                    "type": "number"
                },
                {
                    "text": "fluoride",
                    "template": "fluoride",
                    "type": "plus-minus"
                },
                {
                    "text": "vitamins",
                    "template": "vitamins",
                    "type": "plus-minus"
                },
                {
                    "text": "vitamin type (specify)",
                    "template": "vitamin type: {text}",
                    "type": "alpha"
                },
                {
                    "text": "type of solids\/table foods",
                    "template": "type of solids\/table foods: {text}",
                    "type": "alpha"
                },
                {
                    "text": "vomiting, related to feeding",
                    "template": "vomiting related to feeding is described as {text}",
                    "type": "alpha"
                },
                {
                    "text": "other feeding concerns (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Elimination",
            "template": "Elimination: {children}.",
            "children": [
                {
                    "text": "normal urination",
                    "template": "normal urination"
                },
                {
                    "text": "normal bowel movements",
                    "template": "normal bowel movements"
                },
                {
                    "text": "wet diapers in 24 hrs (#)",
                    "template": "{text} wet diapers in 24 hours",
                    "type": "number"
                },
                {
                    "text": "BMs in 24 hrs (#)",
                    "template": "{text} BMs per 24 hrs",
                    "type": "number"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "color",
                    "template": "stool is {children}",
                    "children": [
                        {
                            "text": "brown",
                            "template": "brown"
                        },
                        {
                            "text": "black",
                            "template": "black"
                        },
                        {
                            "text": "tarry",
                            "template": "tarry"
                        },
                        {
                            "text": "dark red",
                            "template": "dark red"
                        },
                        {
                            "text": "blood-tinged",
                            "template": "blood-tinged"
                        },
                        {
                            "text": "bloody",
                            "template": "bloody"
                        },
                        {
                            "text": "pale",
                            "template": "pale"
                        },
                        {
                            "text": "yellow",
                            "template": "yellow"
                        },
                        {
                            "text": "tan",
                            "template": "tan"
                        },
                        {
                            "text": "green",
                            "template": "green"
                        },
                        {
                            "text": "white\/chalky",
                            "template": "white\/chalky"
                        }
                    ]
                },
                {
                    "text": "consistency",
                    "template": "{children} in consistency",
                    "children": [
                        {
                            "text": "dry, hard",
                            "template": "dry, hard"
                        },
                        {
                            "text": "soft",
                            "template": "soft"
                        },
                        {
                            "text": "lumpy",
                            "template": "lumpy"
                        },
                        {
                            "text": "smooth",
                            "template": "smooth"
                        },
                        {
                            "text": "formed",
                            "template": "formed"
                        },
                        {
                            "text": "mushy",
                            "template": "mushy"
                        },
                        {
                            "text": "liquid",
                            "template": "liquid"
                        },
                        {
                            "text": "thick",
                            "template": "thick"
                        },
                        {
                            "text": "loose",
                            "template": "loose"
                        },
                        {
                            "text": "watery",
                            "template": "watery"
                        },
                        {
                            "text": "mucus",
                            "template": "with mucus"
                        }
                    ]
                },
                {
                    "text": "caliber",
                    "template": "{children} caliber",
                    "children": [
                        {
                            "text": "small caliber",
                            "template": "small"
                        },
                        {
                            "text": "medium caliber",
                            "template": "medium"
                        },
                        {
                            "text": "large caliber",
                            "template": "large"
                        }
                    ]
                },
                {
                    "text": "volume",
                    "template": "{children} volume",
                    "children": [
                        {
                            "text": "small volume",
                            "template": "small"
                        },
                        {
                            "text": "medium volume",
                            "template": "medium"
                        },
                        {
                            "text": "large volume",
                            "template": "large"
                        }
                    ]
                },
                {
                    "text": "frequency (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "other elimination concerns (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Sleep",
            "template": "Sleep: {children}.",
            "children": [
                {
                    "text": "regular sleep schedule",
                    "template": "regular sleep schedule",
                    "type": "plus-minus"
                },
                {
                    "text": "sleeps through the night",
                    "template": "sleeps through the night",
                    "type": "plus-minus"
                },
                {
                    "text": "sleep, hours\/night (specify)",
                    "template": "{text} hours of sleep per night",
                    "type": "number"
                },
                {
                    "text": "naps, hours\/day (#)",
                    "template": "naps {text} hours per day",
                    "type": "number"
                },
                {
                    "text": "other sleep concerns (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Developmental milestones",
            "template": "Developmental Milestones: {children}.",
            "children": [
                {
                    "text": "walks backward (GM)",
                    "template": "walks backward",
                    "type": "plus-minus"
                },
                {
                    "text": "scribbles (FM)",
                    "template": "scribbles",
                    "type": "plus-minus"
                },
                {
                    "text": "stacks 2 blocks (FM)",
                    "template": "stacks 2 blocks",
                    "type": "plus-minus"
                },
                {
                    "text": "uses spoon and fork (PS)",
                    "template": "uses spoon and fork",
                    "type": "plus-minus"
                },
                {
                    "text": "helps with housework (PS)",
                    "template": "helps with housework",
                    "type": "plus-minus"
                },
                {
                    "text": "says 3-6 words (L)",
                    "template": "says 3-6 words",
                    "type": "plus-minus"
                },
                {
                    "text": "follows commands (L)",
                    "template": "follows commands",
                    "type": "plus-minus"
                },
                {
                    "text": "other milestones (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Home environment\/exposures",
            "template": "Home Environment\/Exposures: {children}.",
            "children": [
                {
                    "text": "TB exposure",
                    "template": "TB exposure",
                    "type": "plus-minus"
                },
                {
                    "text": "lead exposure",
                    "template": "exposure to lead",
                    "type": "plus-minus"
                },
                {
                    "text": "chicken pox exposure",
                    "template": "chicken pox exposure",
                    "type": "plus-minus"
                },
                {
                    "text": "pets in home",
                    "template": "pets in home",
                    "type": "plus-minus"
                },
                {
                    "text": "smoking exposure in home",
                    "template": "smoking exposure in home",
                    "type": "plus-minus"
                },
                {
                    "text": "car seat use",
                    "template": "car seat use",
                    "type": "plus-minus"
                },
                {
                    "text": "parental social support available",
                    "template": "parental social support available",
                    "type": "plus-minus"
                },
                {
                    "text": "parental psych support available",
                    "template": "parental psychological support available",
                    "type": "plus-minus"
                },
                {
                    "text": "child care outside of the home",
                    "template": "child care outside of the home",
                    "type": "plus-minus"
                },
                {
                    "text": "inhome caregivers (describe)",
                    "template": "who lives in home with infant: {text}",
                    "type": "alpha"
                },
                {
                    "text": "other environment\/exposures (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Immunizations",
            "template": "Immunizations: {children}.",
            "children": [
                {
                    "text": "up to date",
                    "template": "immunizations up to date"
                },
                {
                    "text": "see record for vaccine hx",
                    "template": "see immunization record for vaccine history"
                },
                {
                    "text": "not performed due to",
                    "template": "immunizations not performed due to",
                    "children": [
                        {
                            "text": "contrication",
                            "template": "contrication"
                        },
                        {
                            "text": "compromised condition",
                            "template": "compromised condition"
                        },
                        {
                            "text": "acute illness",
                            "template": "acute illness"
                        },
                        {
                            "text": "chronic illness",
                            "template": "chronic illness"
                        },
                        {
                            "text": "allergy of vaccine or component",
                            "template": "allergy of vaccine or component"
                        },
                        {
                            "text": "religious belief or group pressure",
                            "template": "religious belief or group pressure"
                        },
                        {
                            "text": "patient refusal",
                            "template": "patient refusal"
                        },
                        {
                            "text": "parent\/caregiver refusal",
                            "template": "parent\/caregiver refusal"
                        }
                    ]
                },
                {
                    "text": "other immunizations (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}