{
    "section": "plan",
    "templateSet": "Fibromyalgia",
    "templates": [
        {
            "text": "Labs",
            "template": "{children}",
            "children": [
                {
                    "text": "Labs",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "CBC w\/ auto diff",
                            "template": "CBC w\/ auto diff"
                        },
                        {
                            "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": "Hepatic function panel (LFTs)",
                            "template": "Hepatic function panel (LFTs)"
                        },
                        {
                            "text": "Calcium, serum",
                            "template": "Calcium, serum"
                        },
                        {
                            "text": "Phosphorus, serum",
                            "template": "Phosphorus, serum"
                        },
                        {
                            "text": "Uric acid, serum",
                            "template": "Uric acid, serum"
                        },
                        {
                            "text": "Creatinine kinase (CK), serum",
                            "template": "Creatinine kinase (CK), serum"
                        },
                        {
                            "text": "Erythrocyte sedimentation rate (ESR)",
                            "template": "Erythrocyte sedimentation rate (ESR)"
                        },
                        {
                            "text": "C-reactive protein (CRP), serum",
                            "template": "C-reactive protein (CRP), serum"
                        },
                        {
                            "text": "TSH (thyroid-stimulating hormone), serum",
                            "template": "TSH (thyroid-stimulating hormone), serum"
                        },
                        {
                            "text": "Thyroxine (T4), free, serum",
                            "template": "Thyroxine (T4), free, serum"
                        },
                        {
                            "text": "Antinuclear antibodies (ANA), serum",
                            "template": "Antinuclear antibodies (ANA), serum"
                        },
                        {
                            "text": "Cyclic citrullinated peptide (CCP) antibody, IgG, serum",
                            "template": "Cyclic citrullinated peptide (CCP) antibody, IgG, serum"
                        },
                        {
                            "text": "Rheumatoid factor (RF), serum",
                            "template": "Rheumatoid factor (RF), serum"
                        },
                        {
                            "text": "Lyme (Borrelia burgdorferi) IgG+IgM antibodies, serum",
                            "template": "Lyme (Borrelia burgdorferi) IgG+IgM antibodies, serum"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Imaging",
            "template": "{children}",
            "children": [
                {
                    "text": "Plain films",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "X-ray",
                            "template": "X-ray"
                        }
                    ]
                },
                {
                    "text": "Ultrasound",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "US",
                            "template": "US"
                        }
                    ]
                },
                {
                    "text": "MRI",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "MRI [specify]",
                            "template": "MRI [specify]"
                        }
                    ]
                },
                {
                    "text": "CT",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "CT [specify]",
                            "template": "CT [specify]"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Procedures",
            "template": "{children}",
            "children": [
                {
                    "text": "Procedures",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Polysomnography (PSG)",
                            "template": "Polysomnography (PSG)"
                        },
                        {
                            "text": "Hydrogen lactulose breath test",
                            "template": "Hydrogen lactulose breath test"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Medications",
            "template": "{children}",
            "children": [
                {
                    "text": "Antidepressants: Selective serontonin reuptake inhibitors",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "citalopram 20 mg tab",
                            "template": "citalopram 20 mg tab"
                        },
                        {
                            "text": "fluoxetine 20 mg cap",
                            "template": "fluoxetine 20 mg cap"
                        },
                        {
                            "text": "paroxetine 20 mg tab",
                            "template": "paroxetine 20 mg tab"
                        },
                        {
                            "text": "sertraline 50 mg tab",
                            "template": "sertraline 50 mg tab"
                        }
                    ]
                },
                {
                    "text": "Antidepressants: Tricyclics",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "amitriptyline 25 mg tab",
                            "template": "amitriptyline 25 mg tab"
                        },
                        {
                            "text": "desipramine 25 mg tab",
                            "template": "desipramine 25 mg tab"
                        },
                        {
                            "text": "imipramine 25 mg tab",
                            "template": "imipramine 25 mg tab"
                        },
                        {
                            "text": "nortriptyline 25 mg cap",
                            "template": "nortriptyline 25 mg cap"
                        }
                    ]
                },
                {
                    "text": "Antidepressants: Serotonin norepinephrine reuptake inhibitors",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "venlafaxine 37.5 mg tab",
                            "template": "venlafaxine 37.5 mg tab"
                        },
                        {
                            "text": "venlafaxine 75 mg tab",
                            "template": "venlafaxine 75 mg tab"
                        },
                        {
                            "text": "Cymbalta 60 mg DR cap",
                            "template": "Cymbalta 60 mg DR cap"
                        },
                        {
                            "text": "Savella 50 mg tab",
                            "template": "Savella 50 mg tab"
                        }
                    ]
                },
                {
                    "text": "Analgesics",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "acetaminophen 500 mg cap",
                            "template": "acetaminophen 500 mg cap"
                        },
                        {
                            "text": "ibuprofen 400 mg tab",
                            "template": "ibuprofen 400 mg tab"
                        },
                        {
                            "text": "naproxen 500 mg tab",
                            "template": "naproxen 500 mg tab"
                        },
                        {
                            "text": "tramadol 50 mg tab",
                            "template": "tramadol 50 mg tab"
                        },
                        {
                            "text": "tramadol 100 mg ER tab",
                            "template": "tramadol 100 mg ER tab"
                        },
                        {
                            "text": "tramadol\/acetaminophen 37.5 mg\/325 mg tab",
                            "template": "tramadol\/acetaminophen 37.5 mg\/325 mg tab"
                        }
                    ]
                },
                {
                    "text": "Antispasmodics",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "cyclobenzaprine 10 mg tab",
                            "template": "cyclobenzaprine 10 mg tab"
                        }
                    ]
                },
                {
                    "text": "Anticonvulsants",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "gabapentin 300 mg cap",
                            "template": "gabapentin 300 mg cap"
                        },
                        {
                            "text": "Lyrica 75 mg cap",
                            "template": "Lyrica 75 mg cap"
                        }
                    ]
                },
                {
                    "text": "Dopamine agonists",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "pramipexole 0.125 mg tab",
                            "template": "pramipexole 0.125 mg tab"
                        },
                        {
                            "text": "ropinirole 0.25 mg tab",
                            "template": "ropinirole 0.25 mg tab"
                        }
                    ]
                },
                {
                    "text": "Sleep\/Anxiety",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "trazodone 50 mg tab",
                            "template": "trazodone 50 mg tab"
                        },
                        {
                            "text": "zaleplon 5 mg cap",
                            "template": "zaleplon 5 mg cap"
                        },
                        {
                            "text": "zolpidem 5 mg tab",
                            "template": "zolpidem 5 mg tab"
                        },
                        {
                            "text": "Ambien CR 12.5 mg ER tab",
                            "template": "Ambien CR 12.5 mg ER tab"
                        },
                        {
                            "text": "Lunesta 2 mg tab",
                            "template": "Lunesta 2 mg tab"
                        },
                        {
                            "text": "Rozerem 8 mg tab",
                            "template": "Rozerem 8 mg tab"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Patient instructions",
            "template": "{children}",
            "children": [
                {
                    "text": "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": "OK to resume usual activities as tolerated",
                            "template": "OK to resume usual activities as tolerated"
                        },
                        {
                            "text": "Avoid jumping, squatting, pressure to knees",
                            "template": "Avoid jumping, squatting, pressure to knees"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Follow-up, Referrals",
            "template": "{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": "Referrals",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "Refer to GI",
                            "template": "Refer to GI"
                        },
                        {
                            "text": "Refer to Neuropsychology",
                            "template": "Refer to Neuropsychology"
                        },
                        {
                            "text": "Refer to Occupational Therapy",
                            "template": "Refer to Occupational Therapy"
                        },
                        {
                            "text": "Refer to PM&R",
                            "template": "Refer to PM&R"
                        },
                        {
                            "text": "Refer to Physical Therapy",
                            "template": "Refer to Physical Therapy"
                        },
                        {
                            "text": "Refer to Psychology",
                            "template": "Refer to Psychology"
                        },
                        {
                            "text": "Refer to Psychiatry",
                            "template": "Refer to Psychiatry"
                        },
                        {
                            "text": "Refer to Rheumatology",
                            "template": "Refer to Rheumatology"
                        },
                        {
                            "text": "Refer to Urology",
                            "template": "Refer to Urology"
                        }
                    ]
                }
            ]
        }
    ]
}