{
    "section": "subjective",
    "templateSet": "Smoking cessation",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "Patient presents for {children}.",
            "children": [
                {
                    "text": "smoking cessation visit",
                    "template": "smoking cessation visit"
                },
                {
                    "text": "initial smoking cessation visit",
                    "template": "initial smoking cessation visit"
                },
                {
                    "text": "follow-up of smoking cessation",
                    "template": "follow-up of smoking cessation"
                },
                {
                    "text": "ongoing smoking cessation management",
                    "template": "ongoing smoking cessation management"
                },
                {
                    "text": "Visit reason (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Symptoms",
            "template": "Patient reports the presence\/absence of the following symptoms related to the current\n                        visit: {children}.\n                    ",
            "children": [
                {
                    "text": "none",
                    "template": "none"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "wheezing",
                    "template": "wheezing",
                    "type": "plus-minus"
                },
                {
                    "text": "SOB",
                    "template": "SOB",
                    "type": "plus-minus"
                },
                {
                    "text": "decreased exercise tolerance",
                    "template": "decreased exercise tolerance",
                    "type": "plus-minus"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Smoking Hx",
            "template": "Patient reports the following smoking Hx: {children}.",
            "children": [
                {
                    "text": "previous smoker",
                    "template": "previous smoker"
                },
                {
                    "text": "current smoker",
                    "template": "current smoker"
                },
                {
                    "text": "tobacco abuse",
                    "template": "tobacco abuse",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco dependence",
                    "template": "tobacco dependence",
                    "type": "plus-minus"
                },
                {
                    "text": "previous quit attempts",
                    "template": "previous quit attempts",
                    "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": "Smoking triggers",
                    "template": "smoking triggers include {children}",
                    "children": [
                        {
                            "text": "meals",
                            "template": "meals"
                        },
                        {
                            "text": "morning coffee",
                            "template": "morning coffee"
                        },
                        {
                            "text": "sex",
                            "template": "sex"
                        },
                        {
                            "text": "social situations",
                            "template": "social situations"
                        },
                        {
                            "text": "drinking alcohol",
                            "template": "drinking alcohol"
                        },
                        {
                            "text": "work breaks",
                            "template": "work breaks"
                        }
                    ]
                },
                {
                    "text": "Packs per day (specify)",
                    "template": "{text} packs per day",
                    "type": "number"
                },
                {
                    "text": "Willingness to quit",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "not willing",
                            "template": "not willing to quit"
                        },
                        {
                            "text": "somewhat willing",
                            "template": "somewhat willing to quit"
                        },
                        {
                            "text": "ready to quit",
                            "template": "ready to quit"
                        }
                    ]
                },
                {
                    "text": "1st cig <30 min awakening",
                    "template": "has first cigarette less than 30 minutes after awakening"
                },
                {
                    "text": "1st cig >30 min awakening",
                    "template": "has first cigarette more than 30 minutes after awakening"
                },
                {
                    "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": "Time since last cig (hours)",
                    "template": "time since last cigarette is {text} hours",
                    "type": "number"
                },
                {
                    "text": "Time since last cig (days)",
                    "template": "time since last cigarette is {text} days",
                    "type": "number"
                },
                {
                    "text": "Time since last cig (weeks)",
                    "template": "time since last cigarette is {text} weeks",
                    "type": "number"
                },
                {
                    "text": "Time since last cig (months)",
                    "template": "time since last cigarette is {text} months",
                    "type": "number"
                },
                {
                    "text": "Time since last cig (years)",
                    "template": "time since last cigarette is {text} years",
                    "type": "number"
                },
                {
                    "text": "tobacco withdrawal",
                    "template": "tobacco withdrawal",
                    "type": "plus-minus"
                },
                {
                    "text": "tobacco remission",
                    "template": "tobacco remission",
                    "type": "plus-minus"
                },
                {
                    "text": "second-hand smoke exposure",
                    "template": "second-hand smoke exposure",
                    "type": "plus-minus"
                },
                {
                    "text": "lives with smoker",
                    "template": "lives with smoker",
                    "type": "plus-minus"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include: {children}.",
            "children": [
                {
                    "text": "chest pain",
                    "template": "chest pain",
                    "type": "plus-minus"
                },
                {
                    "text": "nicotine craving",
                    "template": "nicotine craving",
                    "type": "plus-minus"
                },
                {
                    "text": "depressed mood",
                    "template": "depressed mood",
                    "type": "plus-minus"
                },
                {
                    "text": "irritability",
                    "template": "irritability",
                    "type": "plus-minus"
                },
                {
                    "text": "anxiety",
                    "template": "anxiety",
                    "type": "plus-minus"
                },
                {
                    "text": "anger",
                    "template": "anger",
                    "type": "plus-minus"
                },
                {
                    "text": "restlessness",
                    "template": "restlessness",
                    "type": "plus-minus"
                },
                {
                    "text": "difficulty sleeping",
                    "template": "difficulty sleeping",
                    "type": "plus-minus"
                },
                {
                    "text": "difficulty concentrating",
                    "template": "difficulty concentrating",
                    "type": "plus-minus"
                },
                {
                    "text": "change in appetite",
                    "template": "change in appetite",
                    "type": "plus-minus"
                },
                {
                    "text": "no weight gain",
                    "template": "no weight gain"
                },
                {
                    "text": "weight gain, amount unknown",
                    "template": "weight gain, amount unknown"
                },
                {
                    "text": "weight gain (specify pounds)",
                    "template": "weight gain of {text} pounds",
                    "type": "number"
                },
                {
                    "text": "Other pertinent sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Tx response\/Side effects",
            "template": "Treatment effects: {children}.",
            "children": [
                {
                    "text": "not on treatment",
                    "template": "not on treatment"
                },
                {
                    "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": "not ready to quit",
                            "template": "not ready to quit"
                        },
                        {
                            "text": "side effects",
                            "template": "side effects"
                        },
                        {
                            "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 due to {text}",
                    "type": "alpha"
                },
                {
                    "text": "Treatment response (describe)",
                    "template": "pt describes tx response as {text}",
                    "type": "alpha"
                },
                {
                    "text": "no side effects noted",
                    "template": "no side effects noted"
                },
                {
                    "text": "Common side effects",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "suicidal ideation",
                            "template": "suicidal ideation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "headaches",
                            "template": "headaches",
                            "type": "plus-minus"
                        },
                        {
                            "text": "insomnia",
                            "template": "insomnia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "abnormal dreams",
                            "template": "abnormal dreams",
                            "type": "plus-minus"
                        },
                        {
                            "text": "agitation",
                            "template": "agitation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cough",
                            "template": "cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea\/vomiting",
                            "template": "nausea\/vomiting",
                            "type": "plus-minus"
                        },
                        {
                            "text": "diarrhea",
                            "template": "diarrhea",
                            "type": "plus-minus"
                        },
                        {
                            "text": "constipation",
                            "template": "constipation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "flatulence",
                            "template": "flatulence",
                            "type": "plus-minus"
                        },
                        {
                            "text": "hiccups",
                            "template": "hiccups",
                            "type": "plus-minus"
                        },
                        {
                            "text": "taste changes",
                            "template": "taste changes",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dyspepsia",
                            "template": "dyspepsia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dry mouth",
                            "template": "dry mouth",
                            "type": "plus-minus"
                        },
                        {
                            "text": "mouth\/throat irritation",
                            "template": "mouth\/throat irritation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "tachycardia",
                            "template": "tachycardia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "rash",
                            "template": "rash",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Side effects (describe)",
                    "template": "side effects include {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Previous treatments",
            "template": "Previous smoking cessation treatment history includes {children}.",
            "children": [
                {
                    "text": "nicotine lozenge",
                    "template": "nicotine lozenge ({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": "nicotine gum",
                    "template": "nicotine gum ({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": "nicotine patch",
                    "template": "nicotine patch ({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": "nicotine inhaler",
                    "template": "nicotine inhaler ({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": "nicotine nasal spray",
                    "template": "nicotine nasal spray ({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": "bupropion",
                    "template": "bupropion ({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": "Chantix",
                    "template": "Chantix ({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": "clonidine",
                    "template": "clonidine ({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": "nortriptyline",
                    "template": "nortriptyline ({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 (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical Hx specific to visit: {children}",
            "children": [
                {
                    "text": "frequent respiratory infections",
                    "template": "frequent respiratory infections",
                    "type": "plus-minus"
                },
                {
                    "text": "CAD",
                    "template": "CAD",
                    "type": "plus-minus"
                },
                {
                    "text": "COPD",
                    "template": "COPD",
                    "type": "plus-minus"
                },
                {
                    "text": "CHF",
                    "template": "CHF",
                    "type": "plus-minus"
                },
                {
                    "text": "PVD",
                    "template": "PVD",
                    "type": "plus-minus"
                },
                {
                    "text": "HTN",
                    "template": "HTN",
                    "type": "plus-minus"
                },
                {
                    "text": "GERD\/PUD",
                    "template": "GERD\/PUD",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes type 1",
                    "template": "diabetes type 1",
                    "type": "plus-minus"
                },
                {
                    "text": "diabetes type 2",
                    "template": "diabetes type 2",
                    "type": "plus-minus"
                },
                {
                    "text": "asthma",
                    "template": "asthma",
                    "type": "plus-minus"
                },
                {
                    "text": "depression",
                    "template": "depression",
                    "type": "plus-minus"
                },
                {
                    "text": "anxiety disorder",
                    "template": "anxiety disorder",
                    "type": "plus-minus"
                },
                {
                    "text": "current pregnancy",
                    "template": "current pregnancy",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx of stroke",
                    "template": "Hx of stroke",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx of cancer (specify type)",
                    "template": "Hx cancer ({text})",
                    "type": "alpha"
                },
                {
                    "text": "Other medical Hx (specify)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environment factors",
            "template": "Lifestyle\/Environmental factors include {children}.",
            "children": [
                {
                    "text": "heavy alcohol use",
                    "template": "heavy alcohol use",
                    "type": "plus-minus"
                },
                {
                    "text": "drug use",
                    "template": "drug use",
                    "type": "plus-minus"
                },
                {
                    "text": "IVDU",
                    "template": "IVDU",
                    "type": "plus-minus"
                },
                {
                    "text": "significant stress",
                    "template": "significant stress",
                    "type": "plus-minus"
                },
                {
                    "text": "Occupation (specify)",
                    "template": "occupation: {text}",
                    "type": "alpha"
                },
                {
                    "text": "children at home exposed to smoke",
                    "template": "children at home exposed to smoke"
                },
                {
                    "text": "pets at home exposed to smoke",
                    "template": "pets at home exposed to smoke"
                },
                {
                    "text": "other adults in house",
                    "template": "other adults in house"
                },
                {
                    "text": "Other lifestyle\/exposure (specify)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}