{
    "section": "plan",
    "templateSet": "Myofascial Pelvic Pain",
    "templates": [
        {
            "text": "Ordered Labs",
            "template": "Ordered Labs{children}",
            "children": [
                {
                    "text": "Serum",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Antinuclear antibodies (ANA), serum",
                            "template": "Antinuclear antibodies (ANA), serum"
                        },
                        {
                            "text": "Calcium, serum",
                            "template": "Calcium, serum"
                        },
                        {
                            "text": "CBC w\/ auto diff",
                            "template": "CBC w\/ auto diff"
                        },
                        {
                            "text": "C-reactive protein (CRP), serum",
                            "template": "C-reactive protein (CRP), serum"
                        },
                        {
                            "text": "Cyclic citrullinated peptide (CCP) antibody, IgG, serum",
                            "template": "Cyclic citrullinated peptide (CCP) antibody, IgG, serum"
                        },
                        {
                            "text": "Erythrocyte sedimentation rate (ESR)",
                            "template": "Erythrocyte sedimentation rate (ESR)"
                        },
                        {
                            "text": "Hepatic function panel (LFTs)",
                            "template": "Hepatic function panel (LFTs)"
                        },
                        {
                            "text": "Metabolic panel, basic (BMP), serum",
                            "template": "Metabolic panel, basic (BMP), serum"
                        },
                        {
                            "text": "Metabolic panel, comprehensive (CMP), serum",
                            "template": "Metabolic panel, comprehensive (CMP), serum"
                        },
                        {
                            "text": "Lyme (Borrelia burgdorferi) IgG+IgM antibodies, serum",
                            "template": "Lyme (Borrelia burgdorferi) IgG+IgM antibodies, serum"
                        },
                        {
                            "text": "Phosphorus, serum",
                            "template": "Phosphorus, serum"
                        },
                        {
                            "text": "Rheumatoid factor (RF), serum",
                            "template": "Rheumatoid factor (RF), serum"
                        },
                        {
                            "text": "Uric acid, serum",
                            "template": "Uric acid, serum"
                        }
                    ]
                },
                {
                    "text": "Urine",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Culture, urine, bacterial",
                            "template": "Culture, urine, bacterial"
                        },
                        {
                            "text": "Urinalysis, complete (with micro)",
                            "template": "Urinalysis, complete (with micro)"
                        }
                    ]
                },
                {
                    "text": "Blood culture",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Culture, blood, bacterial x2",
                            "template": "Culture, blood, bacterial x2"
                        }
                    ]
                },
                {
                    "text": "Vaginal cultures",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "GC\/CTM",
                            "template": "GC\/CTM"
                        },
                        {
                            "text": "Vaginal pathogens BV\/Trich\/Mycopl\/Ureaplas\/Candida",
                            "template": "Vaginal pathogens BV\/Trich\/Mycopl\/Ureaplas\/Candida"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Ordered Imaging",
            "template": "Ordered Imaging{children}",
            "children": [
                {
                    "text": "Plain films",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "X-ray spine lumbar",
                            "template": "X-ray spine lumbar"
                        },
                        {
                            "text": "X-ray spine thoracic",
                            "template": "X-ray spine thoracic"
                        }
                    ]
                },
                {
                    "text": "MRI",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "MRI spine thoracic",
                            "template": "MRI spine thoracic"
                        },
                        {
                            "text": "MRI spine lumbar",
                            "template": "MRI spine lumbar"
                        }
                    ]
                },
                {
                    "text": "CT",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "CT spine thoracic",
                            "template": "CT spine thoracic"
                        },
                        {
                            "text": "CT spine lumbar",
                            "template": "CT spine lumbar"
                        }
                    ]
                },
                {
                    "text": "Ultrasound",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Pelvic Ultrasound",
                            "template": "Pelvic Ultrasound"
                        },
                        {
                            "text": "Abdominal ultrasound",
                            "template": "Abdominal ultrasound"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Ordered Medications",
            "template": "Ordered Medications{children}",
            "children": [
                {
                    "text": "OTC pain relievers",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Take OTC acetaminophen prn",
                            "template": "Take OTC acetaminophen prn"
                        },
                        {
                            "text": "Take OTC ibuprofen prn",
                            "template": "Take OTC ibuprofen prn"
                        },
                        {
                            "text": "Take OTC naproxen prn",
                            "template": "Take OTC naproxen prn"
                        },
                        {
                            "text": "Take OTC capsaicin cream (chronic OA)",
                            "template": "Take OTC capsaicin cream (chronic OA)"
                        },
                        {
                            "text": "acetaminophen 500 mg tab",
                            "template": "acetaminophen 500 mg tab"
                        }
                    ]
                },
                {
                    "text": "Anti-inflammatories",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "ibuprofen 400 mg tab",
                            "template": "ibuprofen 400 mg tab"
                        },
                        {
                            "text": "ibuprofen 600 mg tab",
                            "template": "ibuprofen 600 mg tab"
                        },
                        {
                            "text": "ibuprofen 800 mg tab",
                            "template": "ibuprofen 800 mg tab"
                        },
                        {
                            "text": "naproxen 500 mg tab",
                            "template": "naproxen 500 mg tab"
                        },
                        {
                            "text": "Celebrex 200 mg cap",
                            "template": "Celebrex 200 mg cap"
                        },
                        {
                            "text": "Flector 1.3% patch",
                            "template": "Flector 1.3% patch"
                        },
                        {
                            "text": "Medrol 4 mg pack",
                            "template": "Medrol 4 mg pack"
                        },
                        {
                            "text": "Voltaren Gel 1% gel",
                            "template": "Voltaren Gel 1% gel"
                        }
                    ]
                },
                {
                    "text": "Opioids",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "hydrocodone\/acetaminophen 5 mg\/500 mg tab",
                            "template": "hydrocodone\/acetaminophen 5 mg\/500 mg tab"
                        },
                        {
                            "text": "hydrocodone\/ibuprofen 7.5 mg\/200 mg tab",
                            "template": "hydrocodone\/ibuprofen 7.5 mg\/200 mg tab"
                        },
                        {
                            "text": "oxycodone\/acetaminophen 5 mg\/325 mg tab",
                            "template": "oxycodone\/acetaminophen 5 mg\/325 mg tab"
                        }
                    ]
                },
                {
                    "text": "Antispasmodics",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "cyclobenzaprine 5 mg tab",
                            "template": "cyclobenzaprine 5 mg tab"
                        },
                        {
                            "text": "diazepam 2 mg tab",
                            "template": "diazepam 2 mg tab"
                        },
                        {
                            "text": "tizanidine 4 mg tab",
                            "template": "tizanidine 4 mg tab"
                        },
                        {
                            "text": "baclofen 10 mg",
                            "template": "baclofen 10 mg"
                        }
                    ]
                },
                {
                    "text": "Proton pump inhibitors",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "omeprazole 20 mg DR cap",
                            "template": "omeprazole 20 mg DR cap"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Ordered Supplies, Equipment",
            "template": "Ordered Supplies, Equipment{children}",
            "children": [
                {
                    "text": "Supplies",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Pelvic floor massager",
                            "template": "Pelvic floor massager"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Patient Instructions",
            "template": "Patient provided with the following instructions:{children}",
            "children": [
                {
                    "text": "General activity instructions",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Activity as tolerated",
                            "template": "Activity as tolerated"
                        },
                        {
                            "text": "Gentle exercise as tolerated",
                            "template": "Gentle exercise as tolerated"
                        },
                        {
                            "text": "Return to normal activity as tolerated",
                            "template": "Return to normal activity as tolerated"
                        },
                        {
                            "text": "Resume usual activities as tolerated",
                            "template": "Resume usual activities as tolerated"
                        },
                        {
                            "text": "Discontinue bicycle riding",
                            "template": "Discontinue bicycle riding"
                        },
                        {
                            "text": "Hot bath",
                            "template": "Hot bath"
                        }
                    ]
                },
                {
                    "text": "Return to clerical work instructions",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Lift with knees (straight back, no stooping) not more than 5 lbs up to 3 times per\n                                hour\n                            ",
                            "template": "Lift with knees (straight back, no stooping) not more than 5 lbs up to 3 times per\n                                hour\n                            "
                        },
                        {
                            "text": "May squat up to 4 times\/hour",
                            "template": "May squat up to 4 times\/hour"
                        },
                        {
                            "text": "Take a 5-minute break at least every 20 minutes when standing or walking",
                            "template": "Take a 5-minute break at least every 20 minutes when standing or walking"
                        },
                        {
                            "text": "Take a 5-minute break every 30 minutes when sitting",
                            "template": "Take a 5-minute break every 30 minutes when sitting"
                        },
                        {
                            "text": "No extremes of extension or flexion allowed",
                            "template": "No extremes of extension or flexion allowed"
                        },
                        {
                            "text": "No extremes of twisting allowed",
                            "template": "No extremes of twisting allowed"
                        },
                        {
                            "text": "No climbing of ladders allowed",
                            "template": "No climbing of ladders allowed"
                        },
                        {
                            "text": "Limit driving to no more than 2 hours\/day",
                            "template": "Limit driving to no more than 2 hours\/day"
                        }
                    ]
                },
                {
                    "text": "Return to manual work instructions",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Lift with knees (straight back, no stooping) not more than 25 lbs up to 15\n                                times\/hour\n                            ",
                            "template": "Lift with knees (straight back, no stooping) not more than 25 lbs up to 15\n                                times\/hour\n                            "
                        },
                        {
                            "text": "Take a 10-minute break at least every 1-2 hours when sitting or walking",
                            "template": "Take a 10-minute break at least every 1-2 hours when sitting or walking"
                        },
                        {
                            "text": "Take a 10-minute break every 1-2 hours when sitting",
                            "template": "Take a 10-minute break every 1-2 hours when sitting"
                        },
                        {
                            "text": "May drive car or light truck up to a full work day",
                            "template": "May drive car or light truck up to a full work day"
                        }
                    ]
                },
                {
                    "text": "Explanation",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Explained this is not a surgical condition, requires PT",
                            "template": "Explained this is not a surgical condition, requires PT"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Follow-up, Referrals",
            "template": "Follow-up, Referrals{children}",
            "children": [
                {
                    "text": "Return visits",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Return visit as needed",
                            "template": "Return visit as needed"
                        },
                        {
                            "text": "Return visit in 1 week",
                            "template": "Return visit in 1 week"
                        },
                        {
                            "text": "Return visit in 2 weeks",
                            "template": "Return visit in 2 weeks"
                        },
                        {
                            "text": "Return visit in 1 month",
                            "template": "Return visit in 1 month"
                        },
                        {
                            "text": "Return visit in 2 months",
                            "template": "Return visit in 2 months"
                        },
                        {
                            "text": "Return visit in 3 months",
                            "template": "Return visit in 3 months"
                        },
                        {
                            "text": "Return visit in 6 months",
                            "template": "Return visit in 6 months"
                        },
                        {
                            "text": "Return visit in 1 year",
                            "template": "Return visit in 1 year"
                        }
                    ]
                },
                {
                    "text": "Admit to ER\/inpatient care",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Admit to ER",
                            "template": "Admit to ER"
                        },
                        {
                            "text": "Admit to hospital",
                            "template": "Admit to hospital"
                        }
                    ]
                },
                {
                    "text": "Referrals",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Refer for Acupuncture",
                            "template": "Refer for Acupuncture"
                        },
                        {
                            "text": "Refer to Anesthesiology",
                            "template": "Refer to Anesthesiology"
                        },
                        {
                            "text": "Refer to Chiropractic",
                            "template": "Refer to Chiropractic"
                        },
                        {
                            "text": "Refer to Neurology",
                            "template": "Refer to Neurology"
                        },
                        {
                            "text": "Refer to Neurosurgery",
                            "template": "Refer to Neurosurgery"
                        },
                        {
                            "text": "Refer to Orthopedic Surgery",
                            "template": "Refer to Orthopedic Surgery"
                        },
                        {
                            "text": "Refer to Pain Management",
                            "template": "Refer to Pain Management"
                        },
                        {
                            "text": "Refer to Physical Therapy",
                            "template": "Refer to Physical Therapy"
                        },
                        {
                            "text": "Refer to PM&R",
                            "template": "Refer to PM&R"
                        },
                        {
                            "text": "Refer to Psychology",
                            "template": "Refer to Psychology"
                        },
                        {
                            "text": "Refer to Rheumatology",
                            "template": "Refer to Rheumatology"
                        }
                    ]
                }
            ]
        }
    ]
}