{
    "section": "subjective",
    "templateSet": "Headache",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "Patient presents for {children}.",
            "children": [
                {
                    "text": "new onset symptom evaluation",
                    "template": "evaluation of new onset symptoms"
                },
                {
                    "text": "initial headache evaluation",
                    "template": "initial headache evaluation"
                },
                {
                    "text": "follow-up headache evaluation",
                    "template": "follow-up headache evaluation"
                },
                {
                    "text": "ongoing management of headache",
                    "template": "ongoing management of headache"
                },
                {
                    "text": "Visit reason (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Symptoms",
            "template": "Patient reports {children}.",
            "children": [
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "pericranial tenderness",
                    "template": "pericranial tenderness",
                    "type": "plus-minus"
                },
                {
                    "text": "jaw pain",
                    "template": "jaw pain",
                    "type": "plus-minus"
                },
                {
                    "text": "neck pain",
                    "template": "neck pain",
                    "type": "plus-minus"
                },
                {
                    "text": "shoulder pain",
                    "template": "shoulder pain",
                    "type": "plus-minus"
                },
                {
                    "text": "aura",
                    "template": "aura",
                    "type": "plus-minus"
                },
                {
                    "text": "photophobia",
                    "template": "photophobia",
                    "type": "plus-minus"
                },
                {
                    "text": "phonophobia",
                    "template": "phonophobia",
                    "type": "plus-minus"
                },
                {
                    "text": "osmophobia",
                    "template": "osmophobia",
                    "type": "plus-minus"
                },
                {
                    "text": "nausea",
                    "template": "nausea",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "anorexia",
                    "template": "anorexia",
                    "type": "plus-minus"
                },
                {
                    "text": "irritability",
                    "template": "irritability",
                    "type": "plus-minus"
                },
                {
                    "text": "agitation",
                    "template": "agitation",
                    "type": "plus-minus"
                },
                {
                    "text": "sinus pain\/pressure",
                    "template": "sinus pain\/pressure",
                    "type": "plus-minus"
                },
                {
                    "text": "autonomic features",
                    "template": "autonomic features",
                    "type": "plus-minus"
                },
                {
                    "text": "facial sweating",
                    "template": "facial sweating",
                    "type": "plus-minus"
                },
                {
                    "text": "rhinorrhea",
                    "template": "rhinorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal congestion",
                    "template": "nasal congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "tearing",
                    "template": "tearing",
                    "type": "plus-minus"
                },
                {
                    "text": "conjunctival injection",
                    "template": "conjunctival injection",
                    "type": "plus-minus"
                },
                {
                    "text": "eyelid edema",
                    "template": "eyelid edema",
                    "type": "plus-minus"
                },
                {
                    "text": "ptosis",
                    "template": "ptosis",
                    "type": "plus-minus"
                },
                {
                    "text": "other symptoms (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Frequency\/Duration",
            "template": "Symptom {children}.",
            "children": [
                {
                    "text": "acute",
                    "template": "condition is acute"
                },
                {
                    "text": "chronic",
                    "template": "condition is chronic"
                },
                {
                    "text": "periodic",
                    "template": "condition is periodic"
                },
                {
                    "text": "persistent",
                    "template": "condition is persistent"
                },
                {
                    "text": "recurring",
                    "template": "condition is recurring"
                },
                {
                    "text": "Temporal pattern",
                    "template": "occur {children}",
                    "children": [
                        {
                            "text": "before meals",
                            "template": "before meals"
                        },
                        {
                            "text": "during meals",
                            "template": "during meals"
                        },
                        {
                            "text": "after meals",
                            "template": "after meals"
                        },
                        {
                            "text": "in the morning",
                            "template": "in the morning"
                        },
                        {
                            "text": "in the afternoon",
                            "template": "in the afternoon"
                        },
                        {
                            "text": "in the evening",
                            "template": "in the evening"
                        },
                        {
                            "text": "at night",
                            "template": "at night"
                        },
                        {
                            "text": "during sleep",
                            "template": "during sleep"
                        },
                        {
                            "text": "during exertion",
                            "template": "during exertion"
                        }
                    ]
                },
                {
                    "text": "Frequency (times\/day)",
                    "template": "typically occur {text} x\/day",
                    "type": "number"
                },
                {
                    "text": "Frequency (times\/week)",
                    "template": "typically occur {text} x\/wk",
                    "type": "number"
                },
                {
                    "text": "Frequency (times\/month)",
                    "template": "typically occur {text} x\/mo",
                    "type": "number"
                },
                {
                    "text": "Other symptom frequency (specify)",
                    "template": "typically occur",
                    "type": "alpha"
                },
                {
                    "text": "Duration of episode (seconds)",
                    "template": "typically last {text} sec",
                    "type": "number"
                },
                {
                    "text": "Duration of episode (minutes)",
                    "template": "typically last {text} min",
                    "type": "number"
                },
                {
                    "text": "Duration of episode (hours)",
                    "template": "typically last {text} hr",
                    "type": "number"
                },
                {
                    "text": "Other episode duration (specify)",
                    "template": "typically last",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Onset\/Progression",
            "template": "Patient reports {children}.",
            "children": [
                {
                    "text": "Symptom onset (specify)",
                    "template": "symptoms began",
                    "type": "alpha"
                },
                {
                    "text": "gradual onset",
                    "template": "symptoms developed gradually"
                },
                {
                    "text": "sudden onset",
                    "template": "symptoms developed suddenly"
                },
                {
                    "text": "insidious onset",
                    "template": "symptoms developed insidiously"
                },
                {
                    "text": "progressive disease course",
                    "template": "progressive disease course"
                },
                {
                    "text": "stable disease course",
                    "template": "stable disease course"
                },
                {
                    "text": "improving disease course",
                    "template": "improving disease course"
                },
                {
                    "text": "reoccuring disease course",
                    "template": "reoccuring disease course"
                },
                {
                    "text": "Improved since (describe)",
                    "template": "improvement over past",
                    "type": "alpha"
                },
                {
                    "text": "No change since (describe)",
                    "template": "no change over past",
                    "type": "alpha"
                },
                {
                    "text": "Worse since (describe)",
                    "template": "worsening over past",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Location",
            "template": "Location of headache: {children}.",
            "children": [
                {
                    "text": "L-sided headache",
                    "template": "L-sided"
                },
                {
                    "text": "R-sided headache",
                    "template": "R-sided"
                },
                {
                    "text": "BL headache",
                    "template": "bilateral"
                },
                {
                    "text": "generalized headache",
                    "template": "generalized"
                },
                {
                    "text": "side-shifting headache",
                    "template": "side-shifting"
                },
                {
                    "text": "Distribution",
                    "template": "involves",
                    "children": [
                        {
                            "text": "frontal",
                            "template": "frontal region"
                        },
                        {
                            "text": "parietal",
                            "template": "parietal region"
                        },
                        {
                            "text": "temporal",
                            "template": "temporal region"
                        },
                        {
                            "text": "occipital",
                            "template": "occipital region"
                        },
                        {
                            "text": "supraorbital",
                            "template": "supraorbital region"
                        },
                        {
                            "text": "retro-orbital",
                            "template": "retro-orbital region"
                        },
                        {
                            "text": "mastoid",
                            "template": "mastoid region"
                        },
                        {
                            "text": "face",
                            "template": "face"
                        },
                        {
                            "text": "sinuses",
                            "template": "sinuses"
                        },
                        {
                            "text": "ear",
                            "template": "ear"
                        },
                        {
                            "text": "jaw",
                            "template": "jaw"
                        },
                        {
                            "text": "neck",
                            "template": "neck"
                        },
                        {
                            "text": "shoulders",
                            "template": "shoulders"
                        },
                        {
                            "text": "R shoulder",
                            "template": "R shoulder"
                        },
                        {
                            "text": "L shoulder",
                            "template": "L shoulder"
                        }
                    ]
                },
                {
                    "text": "Location\/distribution (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pain quality",
            "template": "Pain is {children} in quality.",
            "children": [
                {
                    "text": "aching",
                    "template": "aching"
                },
                {
                    "text": "burning",
                    "template": "burning"
                },
                {
                    "text": "dull",
                    "template": "dull"
                },
                {
                    "text": "heavy",
                    "template": "heavy"
                },
                {
                    "text": "pounding",
                    "template": "pounding"
                },
                {
                    "text": "pressure",
                    "template": "pressure-like"
                },
                {
                    "text": "sharp",
                    "template": "sharp"
                },
                {
                    "text": "stabbing",
                    "template": "stabbing"
                },
                {
                    "text": "shooting",
                    "template": "shooting"
                },
                {
                    "text": "splitting",
                    "template": "splitting"
                },
                {
                    "text": "squeezing",
                    "template": "squeezing"
                },
                {
                    "text": "throbbing",
                    "template": "throbbing"
                },
                {
                    "text": "other pain quality (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Severity",
            "template": "Pain is {children}.",
            "children": [
                {
                    "text": "mild",
                    "template": "mild"
                },
                {
                    "text": "moderate",
                    "template": "moderate"
                },
                {
                    "text": "severe (incapacitating)",
                    "template": "severe (incapacitating)"
                },
                {
                    "text": "worst headache ever",
                    "template": "described as worst headache ever"
                },
                {
                    "text": "Severity scale (0-10)",
                    "template": "{children} out of 10",
                    "children": [
                        {
                            "text": "0 (no pain)",
                            "template": "0 (no pain)"
                        },
                        {
                            "text": "1",
                            "template": "1"
                        },
                        {
                            "text": "2",
                            "template": "2"
                        },
                        {
                            "text": "3",
                            "template": "3"
                        },
                        {
                            "text": "4",
                            "template": "4"
                        },
                        {
                            "text": "5",
                            "template": "5"
                        },
                        {
                            "text": "6",
                            "template": "6"
                        },
                        {
                            "text": "7",
                            "template": "7"
                        },
                        {
                            "text": "8",
                            "template": "8"
                        },
                        {
                            "text": "9",
                            "template": "9"
                        },
                        {
                            "text": "10 (max pain)",
                            "template": "10 (max pain)"
                        }
                    ]
                },
                {
                    "text": "Other pain severity",
                    "template": "Other pain severity",
                    "type": "alpha"
                },
                {
                    "text": "intractable",
                    "template": "intractable"
                },
                {
                    "text": "not intractable",
                    "template": "not intractable"
                }
            ]
        },
        {
            "text": "Triggers",
            "template": "Triggers include {children}.",
            "children": [
                {
                    "text": "physical exertion",
                    "template": "physical exertion",
                    "type": "plus-minus"
                },
                {
                    "text": "sexual activity",
                    "template": "sexual activity",
                    "type": "plus-minus"
                },
                {
                    "text": "fatigue",
                    "template": "fatigue",
                    "type": "plus-minus"
                },
                {
                    "text": "lack of sleep",
                    "template": "lack of sleep",
                    "type": "plus-minus"
                },
                {
                    "text": "oversleeping",
                    "template": "oversleeping",
                    "type": "plus-minus"
                },
                {
                    "text": "stress",
                    "template": "stress",
                    "type": "plus-minus"
                },
                {
                    "text": "relaxation after stress",
                    "template": "relaxation after stress",
                    "type": "plus-minus"
                },
                {
                    "text": "skipping meals",
                    "template": "skipping meals",
                    "type": "plus-minus"
                },
                {
                    "text": "menstrual cycle",
                    "template": "menstrual cycle",
                    "type": "plus-minus"
                },
                {
                    "text": "menopause",
                    "template": "menopause",
                    "type": "plus-minus"
                },
                {
                    "text": "pregnancy",
                    "template": "pregnancy",
                    "type": "plus-minus"
                },
                {
                    "text": "coughing",
                    "template": "coughing",
                    "type": "plus-minus"
                },
                {
                    "text": "weather changes",
                    "template": "weather changes",
                    "type": "plus-minus"
                },
                {
                    "text": "change in altitude",
                    "template": "change in altitude",
                    "type": "plus-minus"
                },
                {
                    "text": "bright lights",
                    "template": "bright lights",
                    "type": "plus-minus"
                },
                {
                    "text": "loud noise",
                    "template": "loud noise",
                    "type": "plus-minus"
                },
                {
                    "text": "odors\/fragrances",
                    "template": "odors\/fragrances",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco smoke",
                    "template": "tobacco smoke",
                    "type": "plus-minus"
                },
                {
                    "text": "certain foods",
                    "template": "certain foods",
                    "type": "plus-minus"
                },
                {
                    "text": "alcohol",
                    "template": "alcohol",
                    "type": "plus-minus"
                },
                {
                    "text": "caffeine",
                    "template": "caffeine",
                    "type": "plus-minus"
                },
                {
                    "text": "tyramine-rich foods",
                    "template": "tyramine-rich foods",
                    "type": "plus-minus"
                },
                {
                    "text": "MSG",
                    "template": "MSG",
                    "type": "plus-minus"
                },
                {
                    "text": "other triggers (specify)",
                    "template": "other triggers (specify)",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "thunderclap headache",
                    "template": "thunderclap headache",
                    "type": "plus-minus"
                },
                {
                    "text": "new headache pattern",
                    "template": "new headache pattern",
                    "type": "plus-minus"
                },
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "malaise",
                    "template": "malaise",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "weight loss",
                    "template": "weight loss",
                    "type": "plus-minus"
                },
                {
                    "text": "recent fall",
                    "template": "recent fall",
                    "type": "plus-minus"
                },
                {
                    "text": "neck stiffness",
                    "template": "neck stiffness",
                    "type": "plus-minus"
                },
                {
                    "text": "visual changes",
                    "template": "visual changes",
                    "type": "plus-minus"
                },
                {
                    "text": "jaw claudication",
                    "template": "jaw claudication",
                    "type": "plus-minus"
                },
                {
                    "text": "focal numbness",
                    "template": "focal numbness",
                    "type": "plus-minus"
                },
                {
                    "text": "focal weakness",
                    "template": "focal weakness",
                    "type": "plus-minus"
                },
                {
                    "text": "hemiplegia",
                    "template": "hemiplegia",
                    "type": "plus-minus"
                },
                {
                    "text": "seizures",
                    "template": "seizures",
                    "type": "plus-minus"
                },
                {
                    "text": "gait disturbance",
                    "template": "gait disturbance",
                    "type": "plus-minus"
                },
                {
                    "text": "confusion",
                    "template": "confusion",
                    "type": "plus-minus"
                },
                {
                    "text": "difficulty speaking",
                    "template": "difficulty speaking",
                    "type": "plus-minus"
                },
                {
                    "text": "change in memory",
                    "template": "change in memory",
                    "type": "plus-minus"
                },
                {
                    "text": "Other pertinent sx (describe)",
                    "template": "Other pertinent sx (describe)",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Exacerbating\/Alleviating actors",
            "template": "Patient reports that {children}.",
            "children": [
                {
                    "text": "Physical activity",
                    "template": "physical activity {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Movement",
                    "template": "movement {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Bending over",
                    "template": "bending over {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Standing up",
                    "template": "standing up {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Coughing",
                    "template": "coughing {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Valsalva",
                    "template": "the Valsalva maneuver {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been tried",
                            "template": "has not been tried"
                        }
                    ]
                },
                {
                    "text": "Sleep",
                    "template": "sleep {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Lying down",
                    "template": "lying down {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Temporal massage",
                    "template": "temporal massage {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been tried",
                            "template": "has not been tried"
                        }
                    ]
                },
                {
                    "text": "Occipital massage",
                    "template": "occipital massage {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been tried",
                            "template": "has not been tried"
                        }
                    ]
                },
                {
                    "text": "Ice",
                    "template": "ice {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been tried",
                            "template": "has not been tried"
                        }
                    ]
                },
                {
                    "text": "Heat",
                    "template": "heat {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been tried",
                            "template": "has not been tried"
                        }
                    ]
                },
                {
                    "text": "Acetaminophen",
                    "template": "acetaminophen {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been tried",
                            "template": "has not been tried"
                        }
                    ]
                },
                {
                    "text": "NSAIDs",
                    "template": "NSAIDs {children}",
                    "children": [
                        {
                            "text": "improve sx",
                            "template": "improve sx"
                        },
                        {
                            "text": "worsen sx",
                            "template": "worsen sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been tried",
                            "template": "have not been tried"
                        }
                    ]
                },
                {
                    "text": "Ergots",
                    "template": "ergots {children}",
                    "children": [
                        {
                            "text": "improve sx",
                            "template": "improve sx"
                        },
                        {
                            "text": "worsen sx",
                            "template": "worsen sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been tried",
                            "template": "have not been tried"
                        }
                    ]
                },
                {
                    "text": "Triptans",
                    "template": "triptans {children}",
                    "children": [
                        {
                            "text": "improve sx",
                            "template": "improve sx"
                        },
                        {
                            "text": "worsen sx",
                            "template": "worsen sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been tried",
                            "template": "have not been tried"
                        }
                    ]
                },
                {
                    "text": "Other contributing factors (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Tx response",
            "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": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "head trauma",
                    "template": "history of head trauma",
                    "type": "plus-minus"
                },
                {
                    "text": "whiplash",
                    "template": "history of whiplash",
                    "type": "plus-minus"
                },
                {
                    "text": "epidural hematoma",
                    "template": "history of epidural hematoma",
                    "type": "plus-minus"
                },
                {
                    "text": "subdural hematoma",
                    "template": "history of subdural hematoma",
                    "type": "plus-minus"
                },
                {
                    "text": "SAH",
                    "template": "history of subarachnoid hemorrhage",
                    "type": "plus-minus"
                },
                {
                    "text": "TIA",
                    "template": "history of transient ischemic attack",
                    "type": "plus-minus"
                },
                {
                    "text": "AVM",
                    "template": "history of arteriovenous malformation",
                    "type": "plus-minus"
                },
                {
                    "text": "cerebral aneurysm",
                    "template": "history of cerebral aneurysm",
                    "type": "plus-minus"
                },
                {
                    "text": "family Hx of aneurysm",
                    "template": "family history of aneurysm",
                    "type": "plus-minus"
                },
                {
                    "text": "temporal arteritis",
                    "template": "temporal arteritis",
                    "type": "plus-minus"
                },
                {
                    "text": "malignancy",
                    "template": "history of malignancy",
                    "type": "plus-minus"
                },
                {
                    "text": "hypercoagulable state",
                    "template": "history of hypercoagulable state",
                    "type": "plus-minus"
                },
                {
                    "text": "hydrocephalus",
                    "template": "history of hydrocephalus",
                    "type": "plus-minus"
                },
                {
                    "text": "meningitis",
                    "template": "history of meningitis",
                    "type": "plus-minus"
                },
                {
                    "text": "recent lumbar puncture",
                    "template": "recent history of lumbar puncture",
                    "type": "plus-minus"
                },
                {
                    "text": "recent carotid endarterectomy",
                    "template": "recent history of carotid endarterectomy",
                    "type": "plus-minus"
                },
                {
                    "text": "HIV",
                    "template": "history of HIV",
                    "type": "plus-minus"
                },
                {
                    "text": "motion sickness",
                    "template": "history of motion sickness",
                    "type": "plus-minus"
                },
                {
                    "text": "vertigo",
                    "template": "history of vertigo",
                    "type": "plus-minus"
                },
                {
                    "text": "sinusitis",
                    "template": "history of sinusitis",
                    "type": "plus-minus"
                },
                {
                    "text": "recurrent headache",
                    "template": "history of recurrent headache",
                    "type": "plus-minus"
                },
                {
                    "text": "migraine",
                    "template": "migraine",
                    "type": "plus-minus"
                },
                {
                    "text": "family Hx of migraine",
                    "template": "family history of migraine",
                    "type": "plus-minus"
                },
                {
                    "text": "cluster headache",
                    "template": "cluster headache",
                    "type": "plus-minus"
                },
                {
                    "text": "family Hx of cluster headaches",
                    "template": "family Hx of cluster headaches",
                    "type": "plus-minus"
                },
                {
                    "text": "other medical Hx (describe)",
                    "template": "other medical Hx (describe)",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Smoking status",
            "template": "Smoking status: {children}.",
            "children": [
                {
                    "text": "nonsmoker",
                    "template": "nonsmoker"
                },
                {
                    "text": "tobacco abuse",
                    "template": "tobacco abuse",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco dependence",
                    "template": "tobacco dependence",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco products used",
                    "template": "tobacco products used include {children}",
                    "children": [
                        {
                            "text": "cigarettes",
                            "template": "cigarettes"
                        },
                        {
                            "text": "cigars",
                            "template": "cigars"
                        },
                        {
                            "text": "pipes",
                            "template": "pipes"
                        },
                        {
                            "text": "water pipes",
                            "template": "water pipes"
                        },
                        {
                            "text": "chew",
                            "template": "chew"
                        },
                        {
                            "text": "snuff",
                            "template": "snuff"
                        }
                    ]
                },
                {
                    "text": "packs per day (specify)",
                    "template": "{text} packs per day",
                    "type": "number"
                },
                {
                    "text": "age at smoking onset (specify)",
                    "template": "started smoking at age {text}",
                    "type": "number"
                },
                {
                    "text": "smoking duration (months)",
                    "template": "smoking duration is {text} months",
                    "type": "number"
                },
                {
                    "text": "smoking duration (years)",
                    "template": "smoking duration is {text} years",
                    "type": "number"
                },
                {
                    "text": "tobacco withdrawal",
                    "template": "tobacco withdrawal",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco remission",
                    "template": "tobacco remission",
                    "type": "plus-minus"
                },
                {
                    "text": "hx of nicotine dependence (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "second hand smoke type\/exposure (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Meds\/Substance Hx",
            "template": "Patient reports {children}.",
            "children": [
                {
                    "text": "Frequency of HA meds use",
                    "template": "use of medications for headache {text} times per month",
                    "type": "number"
                },
                {
                    "text": "frequent analgesic use",
                    "template": "frequent analgesic use",
                    "type": "plus-minus"
                },
                {
                    "text": "PDE5 inhibitor use",
                    "template": "PDE5 inhibitor use",
                    "type": "plus-minus"
                },
                {
                    "text": "nitrate use",
                    "template": "nitrate use",
                    "type": "plus-minus"
                },
                {
                    "text": "nifedipine use",
                    "template": "nifedipine use",
                    "type": "plus-minus"
                },
                {
                    "text": "oral contraceptive use",
                    "template": "oral contraceptive use",
                    "type": "plus-minus"
                },
                {
                    "text": "regular caffeine use",
                    "template": "regular caffeine use",
                    "type": "plus-minus"
                },
                {
                    "text": "alcohol use",
                    "template": "alcohol use",
                    "type": "plus-minus"
                },
                {
                    "text": "cocaine use",
                    "template": "cocaine use",
                    "type": "plus-minus"
                },
                {
                    "text": "cannabis use",
                    "template": "cannabis use",
                    "type": "plus-minus"
                },
                {
                    "text": "other meds\/substance use (specify)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Previous treatments",
            "template": "Previous treatments include {children}.",
            "children": [
                {
                    "text": "Frequency of HA meds use",
                    "template": "use of medications for headache {text} times per month",
                    "type": "number"
                },
                {
                    "text": "Acupuncture",
                    "template": "acupuncture ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Biofeedback",
                    "template": "biofeedback ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Cognitive behavioral therapy",
                    "template": "cognitive behaviorial therapy ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Cold compresses",
                    "template": "cold compresses ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Warm compresses",
                    "template": "warm compresses ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Massage",
                    "template": "massage ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Physical therapy",
                    "template": "physical therapy ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Relaxation therapy",
                    "template": "relaxation therapy ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Trigger point injections",
                    "template": "trigger point injections ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Occipital nerve block",
                    "template": "occipital nerve block ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Supraorbital nerve block",
                    "template": "supraorbital nerve block ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Acetaminophen",
                    "template": "acetaminophen ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Aspirin",
                    "template": "aspirin ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Butalbital-containing analgesics",
                    "template": "butalbital-containing analgesics ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Caffeine-containing analgesics",
                    "template": "caffeine-containing analgesics ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Combo analgesics",
                    "template": "combo analgesics ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "CoQ10",
                    "template": "CoQ10 ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "DHE",
                    "template": "DHE ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Ergots",
                    "template": "ergots ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Lithium",
                    "template": "lithium ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Magnesium",
                    "template": "magnesium ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "NSAIDs",
                    "template": "NSAIDs ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Opioids",
                    "template": "opioids ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Oxygen",
                    "template": "oxygen ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Steroids",
                    "template": "steroids ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Topiramate",
                    "template": "topiramate ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Triptans",
                    "template": "triptans ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Valproic acid",
                    "template": "valproic acid ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Verapamil",
                    "template": "verapamil ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "positive response",
                            "template": "positive response"
                        },
                        {
                            "text": "partial response",
                            "template": "partial response"
                        },
                        {
                            "text": "no effect",
                            "template": "no effect"
                        },
                        {
                            "text": "negative response",
                            "template": "negative response"
                        },
                        {
                            "text": "discontinued due to side effects",
                            "template": "discontinued due to side effects"
                        }
                    ]
                },
                {
                    "text": "Other previous tx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}
