{
    "section": "subjective",
    "templateSet": "Gynecology Annual Visit",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "Patient presents for {children}.",
            "children": [
                {
                    "text": "well visit, no acute concerns",
                    "template": "well visit, no acute concerns"
                },
                {
                    "text": "annual gynecological visit",
                    "template": "annual gynecological visit"
                },
                {
                    "text": "Pap smear visit",
                    "template": "Pap smear visit"
                },
                {
                    "text": "contraception management",
                    "template": "contraception management"
                },
                {
                    "text": "fertility evaluation",
                    "template": "fertility evaluation"
                },
                {
                    "text": "concerns (specify)",
                    "template": "the following concerns: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Gyn symptoms, LMP",
            "template": "Patient reports {children}.",
            "children": [
                {
                    "text": "LMP began (specify date)",
                    "template": "last menses began {text}",
                    "type": "date"
                },
                {
                    "text": "LMP (describe)",
                    "template": "last menses: {text}",
                    "type": "alpha"
                },
                {
                    "text": "bleeding duration per cycle (specify days)",
                    "template": "bleeding duration per cycle is {text} days",
                    "type": "number"
                },
                {
                    "text": "menstrual cycle",
                    "template": "menstrual cycle is",
                    "children": [
                        {
                            "text": "light",
                            "template": "light"
                        },
                        {
                            "text": "normal",
                            "template": "normal"
                        },
                        {
                            "text": "heavy",
                            "template": "heavy"
                        },
                        {
                            "text": "regular",
                            "template": "regular"
                        },
                        {
                            "text": "irregular",
                            "template": "irregular"
                        }
                    ]
                },
                {
                    "text": "currently menstruating",
                    "template": "currently menstruating"
                },
                {
                    "text": "postmenopausal",
                    "template": "postmenopausal"
                },
                {
                    "text": "no complaints",
                    "template": "no complaints"
                },
                {
                    "text": "Breast sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "breast lump",
                            "template": "breast lump",
                            "type": "plus-minus"
                        },
                        {
                            "text": "breast tenderness",
                            "template": "breast tenderness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "breast tenderness premenstrually",
                            "template": "breast tenderness premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "R breast pain",
                            "template": "right breast pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "L breast pain",
                            "template": "left breast pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nipple discharge",
                            "template": "nipple discharge",
                            "type": "plus-minus"
                        },
                        {
                            "text": "R breast skin redness",
                            "template": "right breast skin redness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "L breast skin redness",
                            "template": "left breast skin redness",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Menstrual\/PMS sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "regular menses",
                            "template": "regular menses"
                        },
                        {
                            "text": "light menses",
                            "template": "light menses"
                        },
                        {
                            "text": "heavy menses",
                            "template": "heavy menses"
                        },
                        {
                            "text": "cessation of menses",
                            "template": "cessation of menses"
                        },
                        {
                            "text": "menstrual irregularity",
                            "template": "menstrual irregularity",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding between periods",
                            "template": "bleeding between periods",
                            "type": "plus-minus"
                        },
                        {
                            "text": "significant pain w\/ menses",
                            "template": "significant pain w\/ menses",
                            "type": "plus-minus"
                        },
                        {
                            "text": "irritability premenstrually",
                            "template": "irritability premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "weight gain premenstrually",
                            "template": "weight gain premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "breast tenderness premenstrually",
                            "template": "breast tenderness premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bloating premenstrually",
                            "template": "bloating premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cramping premenstrually",
                            "template": "cramping premenstrually",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Vaginal discharge sx",
                    "template": "vaginal discharge sx: {children}",
                    "children": [
                        {
                            "text": "no vaginal discharge",
                            "template": "none"
                        },
                        {
                            "text": "thick",
                            "template": "thick"
                        },
                        {
                            "text": "thin",
                            "template": "thin"
                        },
                        {
                            "text": "white",
                            "template": "white"
                        },
                        {
                            "text": "clear",
                            "template": "clear"
                        },
                        {
                            "text": "cloudy",
                            "template": "cloudy"
                        },
                        {
                            "text": "yellow",
                            "template": "yellow"
                        },
                        {
                            "text": "increase amount from usual",
                            "template": "increase amount from usual",
                            "type": "plus-minus"
                        },
                        {
                            "text": "foul smell",
                            "template": "foul smell",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pain in vaginal area",
                            "template": "pain in vaginal area",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Incontinence sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "incontinent of urine",
                            "template": "being incontinent of urine",
                            "type": "plus-minus"
                        },
                        {
                            "text": "urinary incont. w\/ lifting",
                            "template": "urinary incontinence w\/ lifting",
                            "type": "plus-minus"
                        },
                        {
                            "text": "urinary incont. w\/ laughing",
                            "template": "urinary incontinence w\/ laughing",
                            "type": "plus-minus"
                        },
                        {
                            "text": "urinary incont. w\/ full bladder",
                            "template": "urinary incontinence with full bladder",
                            "type": "plus-minus"
                        },
                        {
                            "text": "urge urinary incontinence sx",
                            "template": "urge urinary incontinence sx",
                            "type": "plus-minus"
                        },
                        {
                            "text": "fecal incontinence",
                            "template": "fecal incontinence",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nocturnal need for urination",
                            "template": "nocturnal need for urination",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Menopausal sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "hot flashes",
                            "template": "hot flashes",
                            "type": "plus-minus"
                        },
                        {
                            "text": "hot flashes disturbing sleep",
                            "template": "hot flashes disturbing sleep",
                            "type": "plus-minus"
                        },
                        {
                            "text": "vaginal dryness",
                            "template": "vaginal dryness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "mood instability",
                            "template": "mood instability",
                            "type": "plus-minus"
                        },
                        {
                            "text": "thinning hair",
                            "template": "thinning hair",
                            "type": "plus-minus"
                        },
                        {
                            "text": "weight gain",
                            "template": "weight gain",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Pain sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "pelvic pain",
                            "template": "pelvic pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "cramping",
                            "template": "cramping",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dysuria",
                            "template": "dysuria",
                            "type": "plus-minus"
                        },
                        {
                            "text": "painful intercourse",
                            "template": "painful intercourse",
                            "type": "plus-minus"
                        },
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Sexual sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "loss of interest in sex",
                            "template": "loss of interest in sex",
                            "type": "plus-minus"
                        },
                        {
                            "text": "loss of sexual pleasure",
                            "template": "loss of sexual pleasure",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pain w\/ intercourse",
                            "template": "pain w\/ intercourse",
                            "type": "plus-minus"
                        },
                        {
                            "text": "vaginal dryness",
                            "template": "vaginal dryness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding after intercourse",
                            "template": "bleeding after intercourse",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Other symptoms (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "anxiety",
                    "template": "anxiety",
                    "type": "plus-minus"
                },
                {
                    "text": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "decreased exercise tolerance",
                    "template": "decreased exercise tolerance",
                    "type": "plus-minus"
                },
                {
                    "text": "depression",
                    "template": "depression",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "dizziness",
                    "template": "dizziness",
                    "type": "plus-minus"
                },
                {
                    "text": "fatigue",
                    "template": "fatigue",
                    "type": "plus-minus"
                },
                {
                    "text": "feeling hopeless",
                    "template": "feeling hopeless",
                    "type": "plus-minus"
                },
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "focal extremity weakness",
                    "template": "focal extremity weakness",
                    "type": "plus-minus"
                },
                {
                    "text": "focal extremity numbness",
                    "template": "focal extremity numbness",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "lightheadedness",
                    "template": "lightheadedness",
                    "type": "plus-minus"
                },
                {
                    "text": "lower extremity edema",
                    "template": "lower extremity edema",
                    "type": "plus-minus"
                },
                {
                    "text": "nausea",
                    "template": "nausea",
                    "type": "plus-minus"
                },
                {
                    "text": "nocturia",
                    "template": "nocturia",
                    "type": "plus-minus"
                },
                {
                    "text": "pain",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "back pain",
                            "template": "back pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "chest pain",
                            "template": "chest pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "joint pain",
                            "template": "joint pain",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "paresthesias",
                    "template": "paresthesias",
                    "type": "plus-minus"
                },
                {
                    "text": "sleep disturbance",
                    "template": "sleep disturbance",
                    "type": "plus-minus"
                },
                {
                    "text": "shortness of breath",
                    "template": "shortness of breath",
                    "type": "plus-minus"
                },
                {
                    "text": "visual changes",
                    "template": "visual changes",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "weight gain",
                    "template": "weight gain",
                    "type": "plus-minus"
                },
                {
                    "text": "weight loss",
                    "template": "weight loss",
                    "type": "plus-minus"
                },
                {
                    "text": "changes in stool",
                    "template": "changes in stool",
                    "type": "plus-minus"
                },
                {
                    "text": "change in moles",
                    "template": "change in moles",
                    "type": "plus-minus"
                },
                {
                    "text": "other sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Sexual Hx\/activity",
            "template": "Sexual Hx: {children}.",
            "children": [
                {
                    "text": ">4 sex partners in lifetime",
                    "template": ">4 sex partners in lifetime"
                },
                {
                    "text": "4 or fewer sex partners in lifetime",
                    "template": "4 or fewer sex partners in lifetime"
                },
                {
                    "text": "number of partners, lifetime",
                    "template": "number of partners, lifetime: {text}",
                    "type": "number"
                },
                {
                    "text": "sexually active",
                    "template": "sexually active",
                    "type": "plus-minus"
                },
                {
                    "text": "safe sex practices",
                    "template": "safe sex practices",
                    "type": "plus-minus"
                },
                {
                    "text": "sexual symptoms",
                    "template": "sexual sx: {children}",
                    "children": [
                        {
                            "text": "loss of interest in sex",
                            "template": "loss of interest in sex",
                            "type": "plus-minus"
                        },
                        {
                            "text": "loss of sexual pleasure",
                            "template": "loss of sexual pleasure",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pain w\/ intercourse",
                            "template": "pain w\/ intercourse",
                            "type": "plus-minus"
                        },
                        {
                            "text": "vaginal dryness",
                            "template": "vaginal dryness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding after intercourse",
                            "template": "bleeding after intercourse",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "sexual partners are male",
                    "template": "sexual partners are male"
                },
                {
                    "text": "sexual partners are female",
                    "template": "sexual partners are female"
                },
                {
                    "text": "sexual partners are male and female",
                    "template": "sexual partners are male and female"
                },
                {
                    "text": "other sexual hx\/activity",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Fertility\/Conception",
            "template": "Conception: {children}.",
            "children": [
                {
                    "text": "patient desires conception",
                    "template": "patient desires conception"
                },
                {
                    "text": "patient does not desire conception",
                    "template": "patient does not desire conception"
                },
                {
                    "text": "desires pregnancy test",
                    "template": "desires pregnancy test"
                },
                {
                    "text": "taking folic acid 800 mcg or more",
                    "template": "currently taking folic acid 800 mcg or more",
                    "type": "plus-minus"
                },
                {
                    "text": "concerns regarding genetic risks",
                    "template": "concerns regarding genetic risks",
                    "type": "plus-minus"
                },
                {
                    "text": "sex partner desires conception",
                    "template": "sex partner desires conception",
                    "type": "plus-minus"
                },
                {
                    "text": "conception concerns (describe)",
                    "template": "conception concerns: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Contraception use\/side effects",
            "template": "Contraception: {children}.",
            "children": [
                {
                    "text": "not currently on contraception",
                    "template": "patient not currently on contraception"
                },
                {
                    "text": "birth control type",
                    "template": "type of birth control: {children}",
                    "children": [
                        {
                            "text": "oral contraceptives",
                            "template": "oral contraceptives"
                        },
                        {
                            "text": "monophasic oral contraceptives",
                            "template": "monophasic oral contraceptives"
                        },
                        {
                            "text": "biphasic oral contraceptives",
                            "template": "biphasic oral contraceptives"
                        },
                        {
                            "text": "triphasic oral contraceptives",
                            "template": "triphasic oral contraceptives"
                        },
                        {
                            "text": "extended cycle oral contraceptives",
                            "template": "extended cycle oral contraceptives"
                        },
                        {
                            "text": "progestin-only oral contraceptives",
                            "template": "progestin-only oral contraceptives"
                        },
                        {
                            "text": "hormonal patch",
                            "template": "hormonal patch"
                        },
                        {
                            "text": "male condom",
                            "template": "male condom"
                        },
                        {
                            "text": "female condom",
                            "template": "female condom"
                        },
                        {
                            "text": "diaphragm",
                            "template": "diaphragm"
                        },
                        {
                            "text": "spermicide",
                            "template": "spermicide"
                        },
                        {
                            "text": "vaginal ring",
                            "template": "vaginal ring"
                        },
                        {
                            "text": "cervical cap",
                            "template": "cervical cap"
                        },
                        {
                            "text": "contraceptive sponge",
                            "template": "contraceptive sponge"
                        },
                        {
                            "text": "IUD",
                            "template": "IUD"
                        },
                        {
                            "text": "intradermal implant",
                            "template": "intradermal implant"
                        },
                        {
                            "text": "monthly injection",
                            "template": "monthly injection"
                        },
                        {
                            "text": "rhythm method\/fertility awareness",
                            "template": "rhythm method\/fertility awareness"
                        },
                        {
                            "text": "emergency contraceptive pills",
                            "template": "emergency contraceptive pills"
                        },
                        {
                            "text": "partner is sterilized",
                            "template": "partner is sterilized"
                        }
                    ]
                },
                {
                    "text": "birth control type (specify)",
                    "template": "type of birth control: {text}",
                    "type": "alpha"
                },
                {
                    "text": "satisfied with current contraception",
                    "template": "satisfied with current contraception"
                },
                {
                    "text": "consistent contraception use",
                    "template": "consistent contraception use",
                    "type": "plus-minus"
                },
                {
                    "text": "no side effects noted",
                    "template": "no side effects noted"
                },
                {
                    "text": "common contraception side effects",
                    "template": "side effects include: {children}",
                    "children": [
                        {
                            "text": "abdominal pain",
                            "template": "abdominal pain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "acne",
                            "template": "acne",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bloating",
                            "template": "bloating",
                            "type": "plus-minus"
                        },
                        {
                            "text": "breast tenderness",
                            "template": "breast tenderness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding between periods",
                            "template": "bleeding between periods",
                            "type": "plus-minus"
                        },
                        {
                            "text": "emotional instability",
                            "template": "emotional instability",
                            "type": "plus-minus"
                        },
                        {
                            "text": "headache",
                            "template": "headache",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea",
                            "type": "plus-minus"
                        },
                        {
                            "text": "lower extremity edema",
                            "template": "lower extremity edema",
                            "type": "plus-minus"
                        },
                        {
                            "text": "melasma",
                            "template": "melasma",
                            "type": "plus-minus"
                        },
                        {
                            "text": "patch application site irritation",
                            "template": "patch application site irritation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "weight gain",
                            "template": "weight gain",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "side effects (describe)",
                    "template": "side effects: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Previous contraception Hx",
            "template": "Previous contraception history includes {children}.",
            "children": [
                {
                    "text": "no previous contraception history",
                    "template": "no previous contraception history"
                },
                {
                    "text": "oral contraceptives",
                    "template": "oral contraceptives ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "combination estrogen\/progestin pills",
                    "template": "combination estrogen\/progestin pills ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "monophasic oral contraceptives",
                    "template": "monophasic oral contraceptives ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "biphasic oral contraceptives",
                    "template": "biphasic oral contraceptives ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "triphasic oral contraceptives",
                    "template": "triphasic oral contraceptives ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "progestin-only oral contraceptives",
                    "template": "progestin-only oral contraceptives ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "hormonal patch contraceptives",
                    "template": "hormonal patch contraceptives ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "rhythm method\/fertility awareness",
                    "template": "rhythm method\/fertility awareness ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "male condom",
                    "template": "male condom ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "female condom",
                    "template": "female condom ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "diaphragm",
                    "template": "diaphragm ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "spermicide",
                    "template": "spermicide ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "vaginal ring",
                    "template": "vaginal ring ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "IUD",
                    "template": "IUD ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "cervical cap",
                    "template": "cervical cap ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "contraceptive sponge",
                    "template": "contraceptive sponge ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "intradermal implant",
                    "template": "intradermal implant ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "monthly injection",
                    "template": "monthly injection ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "emergency contraceptive pills",
                    "template": "emergency contraceptive pills ({children})",
                    "children": [
                        {
                            "text": "not tried",
                            "template": "not tried"
                        },
                        {
                            "text": "well tolerated",
                            "template": "well tolerated"
                        },
                        {
                            "text": "inconsistently used",
                            "template": "inconsistently used"
                        },
                        {
                            "text": "poorly tolerated",
                            "template": "poorly tolerated"
                        },
                        {
                            "text": "d\/c'd due to side effects",
                            "template": "discontinued due to side effects"
                        },
                        {
                            "text": "ineffective",
                            "template": "ineffective"
                        }
                    ]
                },
                {
                    "text": "partner is sterilized",
                    "template": "partner is sterilized"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "OB\/Gyn Hx specific to visit",
            "template": "OB\/Gyn history includes {children}.",
            "children": [
                {
                    "text": "menarche prior to 12 yo",
                    "template": "menarche prior to 12 yo",
                    "type": "plus-minus"
                },
                {
                    "text": "menopause later than 51 yo",
                    "template": "menopause later than 51 yo",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx breastfeeding",
                    "template": "Hx breastfeeding",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx oligomenorrhea",
                    "template": "Hx oligomenorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx infertility",
                    "template": "Hx infertility",
                    "type": "plus-minus"
                },
                {
                    "text": "Abnormal Pap smear (describe)",
                    "template": "(+) abnormal Pap smear, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Colposcopy (describe)",
                    "template": "(+) colposcopy, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Cervical biopsy (describe)",
                    "template": "(+) cervical biopsy, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Cervical surgery (describe)",
                    "template": "(+) cervical surgery, [xxx}",
                    "type": "alpha"
                },
                {
                    "text": "Abnormal mammogram",
                    "template": "(+) abnormal mammogram, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Breast biopsy (describe)",
                    "template": "(+) breast biopsy, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Breast cyst drainage (describe)",
                    "template": "(+) breast cyst drainage, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Breast surgery (describe)",
                    "template": "(+) breast surgery, {text}",
                    "type": "alpha"
                },
                {
                    "text": "Hx surgery (describe)",
                    "template": "(+) Hx surgery: {text}",
                    "type": "alpha"
                },
                {
                    "text": "Other OB\/Gyn Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Past Pregnancy #1",
            "template": "Past Pregnancies #1. {children}.",
            "children": [
                {
                    "text": "date (month\/year)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "GA weeks (#)",
                    "template": "gestational age at birth {text} weeks",
                    "type": "number"
                },
                {
                    "text": "length of labor (describe)",
                    "template": "length of labor was {text}",
                    "type": "alpha"
                },
                {
                    "text": "baby's birth weight (specify)",
                    "template": "baby's weight at birth {text}",
                    "type": "alpha"
                },
                {
                    "text": "sex",
                    "template": "sex:",
                    "children": [
                        {
                            "text": "female",
                            "template": "female"
                        },
                        {
                            "text": "male",
                            "template": "male"
                        }
                    ]
                },
                {
                    "text": "type of delivery",
                    "template": "{children} delivery",
                    "children": [
                        {
                            "text": "vaginal",
                            "template": "vaginal"
                        },
                        {
                            "text": "cesarean section",
                            "template": "cesarean section"
                        },
                        {
                            "text": "vaginal birth after cesarean (VBAC)",
                            "template": "vaginal birth after cesarean (VBAC)"
                        }
                    ]
                },
                {
                    "text": "anesthesia",
                    "template": "anesthesia type:",
                    "children": [
                        {
                            "text": "epidural",
                            "template": "epidural"
                        },
                        {
                            "text": "spinal",
                            "template": "spinal"
                        },
                        {
                            "text": "local",
                            "template": "local"
                        },
                        {
                            "text": "Pudendal block",
                            "template": "Pudendal block"
                        },
                        {
                            "text": "sedation",
                            "template": "sedation"
                        },
                        {
                            "text": "general",
                            "template": "general"
                        },
                        {
                            "text": "none",
                            "template": "none"
                        }
                    ]
                },
                {
                    "text": "place of delivery (list)",
                    "template": "delivered at {text}",
                    "type": "alpha"
                },
                {
                    "text": "preterm labor",
                    "template": "preterm labor",
                    "type": "plus-minus"
                },
                {
                    "text": "comments\/complications (describe)",
                    "template": "additional comments\/complications: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Past Pregnancy #2",
            "template": "#2. {children}.",
            "children": [
                {
                    "text": "date (month\/year)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "GA weeks (#)",
                    "template": "gestational age at birth {text} weeks",
                    "type": "number"
                },
                {
                    "text": "length of labor (describe)",
                    "template": "length of labor was {text}",
                    "type": "alpha"
                },
                {
                    "text": "baby's birth weight (specify)",
                    "template": "baby's weight at birth {text}",
                    "type": "alpha"
                },
                {
                    "text": "sex",
                    "template": "sex:",
                    "children": [
                        {
                            "text": "female",
                            "template": "female"
                        },
                        {
                            "text": "male",
                            "template": "male"
                        }
                    ]
                },
                {
                    "text": "type of delivery",
                    "template": "{children} delivery",
                    "children": [
                        {
                            "text": "vaginal",
                            "template": "vaginal"
                        },
                        {
                            "text": "cesarean section",
                            "template": "cesarean section"
                        },
                        {
                            "text": "vaginal birth after cesarean (VBAC)",
                            "template": "vaginal birth after cesarean (VBAC)"
                        }
                    ]
                },
                {
                    "text": "anesthesia",
                    "template": "anesthesia type:",
                    "children": [
                        {
                            "text": "epidural",
                            "template": "epidural"
                        },
                        {
                            "text": "spinal",
                            "template": "spinal"
                        },
                        {
                            "text": "local",
                            "template": "local"
                        },
                        {
                            "text": "Pudendal block",
                            "template": "Pudendal block"
                        },
                        {
                            "text": "sedation",
                            "template": "sedation"
                        },
                        {
                            "text": "general",
                            "template": "general"
                        },
                        {
                            "text": "none",
                            "template": "none"
                        }
                    ]
                },
                {
                    "text": "place of delivery (list)",
                    "template": "delivered at {text}",
                    "type": "alpha"
                },
                {
                    "text": "preterm labor",
                    "template": "preterm labor",
                    "type": "plus-minus"
                },
                {
                    "text": "comments\/complications (describe)",
                    "template": "additional comments\/complications: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Past Pregnancy #3",
            "template": "#3. {children}.",
            "children": [
                {
                    "text": "date (month\/year)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "GA weeks (#)",
                    "template": "gestational age at birth {text} weeks",
                    "type": "number"
                },
                {
                    "text": "length of labor (describe)",
                    "template": "length of labor was {text}",
                    "type": "alpha"
                },
                {
                    "text": "baby's birth weight (specify)",
                    "template": "baby's weight at birth {text}",
                    "type": "alpha"
                },
                {
                    "text": "sex",
                    "template": "sex:",
                    "children": [
                        {
                            "text": "female",
                            "template": "female"
                        },
                        {
                            "text": "male",
                            "template": "male"
                        }
                    ]
                },
                {
                    "text": "type of delivery",
                    "template": "{children} delivery",
                    "children": [
                        {
                            "text": "vaginal",
                            "template": "vaginal"
                        },
                        {
                            "text": "cesarean section",
                            "template": "cesarean section"
                        },
                        {
                            "text": "vaginal birth after cesarean (VBAC)",
                            "template": "vaginal birth after cesarean (VBAC)"
                        }
                    ]
                },
                {
                    "text": "anesthesia",
                    "template": "anesthesia type:",
                    "children": [
                        {
                            "text": "epidural",
                            "template": "epidural"
                        },
                        {
                            "text": "spinal",
                            "template": "spinal"
                        },
                        {
                            "text": "local",
                            "template": "local"
                        },
                        {
                            "text": "Pudendal block",
                            "template": "Pudendal block"
                        },
                        {
                            "text": "sedation",
                            "template": "sedation"
                        },
                        {
                            "text": "general",
                            "template": "general"
                        },
                        {
                            "text": "none",
                            "template": "none"
                        }
                    ]
                },
                {
                    "text": "place of delivery (list)",
                    "template": "delivered at {text}",
                    "type": "alpha"
                },
                {
                    "text": "preterm labor",
                    "template": "preterm labor",
                    "type": "plus-minus"
                },
                {
                    "text": "comments\/complications (describe)",
                    "template": "additional comments\/complications: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Past Pregnancy #4",
            "template": "#4. {children}.",
            "children": [
                {
                    "text": "date (month\/year)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "GA weeks (#)",
                    "template": "gestational age at birth {text} weeks",
                    "type": "number"
                },
                {
                    "text": "length of labor (describe)",
                    "template": "length of labor was {text}",
                    "type": "alpha"
                },
                {
                    "text": "baby's birth weight (specify)",
                    "template": "baby's weight at birth {text}",
                    "type": "alpha"
                },
                {
                    "text": "sex",
                    "template": "sex:",
                    "children": [
                        {
                            "text": "female",
                            "template": "female"
                        },
                        {
                            "text": "male",
                            "template": "male"
                        }
                    ]
                },
                {
                    "text": "type of delivery",
                    "template": "{children} delivery",
                    "children": [
                        {
                            "text": "vaginal",
                            "template": "vaginal"
                        },
                        {
                            "text": "cesarean section",
                            "template": "cesarean section"
                        },
                        {
                            "text": "vaginal birth after cesarean (VBAC)",
                            "template": "vaginal birth after cesarean (VBAC)"
                        }
                    ]
                },
                {
                    "text": "anesthesia",
                    "template": "anesthesia type:",
                    "children": [
                        {
                            "text": "epidural",
                            "template": "epidural"
                        },
                        {
                            "text": "spinal",
                            "template": "spinal"
                        },
                        {
                            "text": "local",
                            "template": "local"
                        },
                        {
                            "text": "Pudendal block",
                            "template": "Pudendal block"
                        },
                        {
                            "text": "sedation",
                            "template": "sedation"
                        },
                        {
                            "text": "general",
                            "template": "general"
                        },
                        {
                            "text": "none",
                            "template": "none"
                        }
                    ]
                },
                {
                    "text": "place of delivery (list)",
                    "template": "delivered at {text}",
                    "type": "alpha"
                },
                {
                    "text": "preterm labor",
                    "template": "preterm labor",
                    "type": "plus-minus"
                },
                {
                    "text": "comments\/complications (describe)",
                    "template": "additional comments\/complications: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Past Pregnancy #5",
            "template": "#5. {children}.",
            "children": [
                {
                    "text": "date (month\/year)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "GA weeks (#)",
                    "template": "gestational age at birth {text} weeks",
                    "type": "number"
                },
                {
                    "text": "length of labor (describe)",
                    "template": "length of labor was {text}",
                    "type": "alpha"
                },
                {
                    "text": "baby's birth weight (specify)",
                    "template": "baby's weight at birth {text}",
                    "type": "alpha"
                },
                {
                    "text": "sex",
                    "template": "sex:",
                    "children": [
                        {
                            "text": "female",
                            "template": "female"
                        },
                        {
                            "text": "male",
                            "template": "male"
                        }
                    ]
                },
                {
                    "text": "type of delivery",
                    "template": "{children} delivery",
                    "children": [
                        {
                            "text": "vaginal",
                            "template": "vaginal"
                        },
                        {
                            "text": "cesarean section",
                            "template": "cesarean section"
                        },
                        {
                            "text": "vaginal birth after cesarean (VBAC)",
                            "template": "vaginal birth after cesarean (VBAC)"
                        }
                    ]
                },
                {
                    "text": "anesthesia",
                    "template": "anesthesia type:",
                    "children": [
                        {
                            "text": "epidural",
                            "template": "epidural"
                        },
                        {
                            "text": "spinal",
                            "template": "spinal"
                        },
                        {
                            "text": "local",
                            "template": "local"
                        },
                        {
                            "text": "Pudendal block",
                            "template": "Pudendal block"
                        },
                        {
                            "text": "sedation",
                            "template": "sedation"
                        },
                        {
                            "text": "general",
                            "template": "general"
                        },
                        {
                            "text": "none",
                            "template": "none"
                        }
                    ]
                },
                {
                    "text": "place of delivery (list)",
                    "template": "delivered at {text}",
                    "type": "alpha"
                },
                {
                    "text": "preterm labor",
                    "template": "preterm labor",
                    "type": "plus-minus"
                },
                {
                    "text": "comments\/complications (describe)",
                    "template": "additional comments\/complications: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Past Pregnancy #6",
            "template": "#6. {children}.",
            "children": [
                {
                    "text": "date (month\/year)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "GA weeks (#)",
                    "template": "gestational age at birth {text} weeks",
                    "type": "number"
                },
                {
                    "text": "length of labor (describe)",
                    "template": "length of labor was {text}",
                    "type": "alpha"
                },
                {
                    "text": "baby's birth weight (specify)",
                    "template": "baby's weight at birth {text}",
                    "type": "alpha"
                },
                {
                    "text": "sex",
                    "template": "sex:",
                    "children": [
                        {
                            "text": "female",
                            "template": "female"
                        },
                        {
                            "text": "male",
                            "template": "male"
                        }
                    ]
                },
                {
                    "text": "type of delivery",
                    "template": "{children} delivery",
                    "children": [
                        {
                            "text": "vaginal",
                            "template": "vaginal"
                        },
                        {
                            "text": "cesarean section",
                            "template": "cesarean section"
                        },
                        {
                            "text": "vaginal birth after cesarean (VBAC)",
                            "template": "vaginal birth after cesarean (VBAC)"
                        }
                    ]
                },
                {
                    "text": "anesthesia",
                    "template": "anesthesia type:",
                    "children": [
                        {
                            "text": "epidural",
                            "template": "epidural"
                        },
                        {
                            "text": "spinal",
                            "template": "spinal"
                        },
                        {
                            "text": "local",
                            "template": "local"
                        },
                        {
                            "text": "Pudendal block",
                            "template": "Pudendal block"
                        },
                        {
                            "text": "sedation",
                            "template": "sedation"
                        },
                        {
                            "text": "general",
                            "template": "general"
                        },
                        {
                            "text": "none",
                            "template": "none"
                        }
                    ]
                },
                {
                    "text": "place of delivery (list)",
                    "template": "delivered at {text}",
                    "type": "alpha"
                },
                {
                    "text": "preterm labor",
                    "template": "preterm labor",
                    "type": "plus-minus"
                },
                {
                    "text": "comments\/complications (describe)",
                    "template": "additional comments\/complications: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "migraines",
                    "template": "migraines",
                    "type": "plus-minus"
                },
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "coronary artery disease",
                    "template": "coronary artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "symptomatic carotid artery disease",
                    "template": "symptomatic carotid artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "peripheral artery disease",
                    "template": "peripheral artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "abdominal aortic aneurysm",
                    "template": "abdominal aortic aneurysm",
                    "type": "plus-minus"
                },
                {
                    "text": "hx oligomenorrhea",
                    "template": "hx oligomenorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "DVT",
                    "template": "DVT",
                    "type": "plus-minus"
                },
                {
                    "text": "hyperlipidemia",
                    "template": "hyperlipidemia",
                    "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": "hypothyroidism",
                    "template": "hypothyroidism",
                    "type": "plus-minus"
                },
                {
                    "text": "liver disease",
                    "template": "liver disease",
                    "type": "plus-minus"
                },
                {
                    "text": "HPV infection",
                    "template": "HPV infection",
                    "type": "plus-minus"
                },
                {
                    "text": "bacterial vaginosis",
                    "template": "bacterial vaginosis",
                    "type": "plus-minus"
                },
                {
                    "text": "chlamydia",
                    "template": "chlamydia",
                    "type": "plus-minus"
                },
                {
                    "text": "gonorrhea",
                    "template": "gonorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "herpes",
                    "template": "herpes",
                    "type": "plus-minus"
                },
                {
                    "text": "syphilis",
                    "template": "syphilis",
                    "type": "plus-minus"
                },
                {
                    "text": "overweight\/obesity",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "overweight",
                            "template": "overweight",
                            "type": "plus-minus"
                        },
                        {
                            "text": "obese",
                            "template": "obese",
                            "type": "plus-minus"
                        },
                        {
                            "text": "morbid obesity",
                            "template": "morbid obesity",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "obesity contributing factors (describe)",
                    "template": "obesity contributing factors {text}",
                    "type": "alpha"
                },
                {
                    "text": "cancer history (describe)",
                    "template": "(+) cancer, {text}",
                    "type": "alpha"
                },
                {
                    "text": "hx surgery (describe)",
                    "template": "(+) hx surgery: {text}",
                    "type": "alpha"
                },
                {
                    "text": "other medical hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environmental factors",
            "template": "Lifestyle\/Environment factors include {children}.",
            "children": [
                {
                    "text": "sedentary lifestyle",
                    "template": "sedentary lifestyle",
                    "type": "plus-minus"
                },
                {
                    "text": "regular exercise",
                    "template": "regular exercise",
                    "type": "plus-minus"
                },
                {
                    "text": "safe sexual practices",
                    "template": "safe sexual practices",
                    "type": "plus-minus"
                },
                {
                    "text": "adequate calcium intake",
                    "template": "adequate calcium intake",
                    "type": "plus-minus"
                },
                {
                    "text": "high-fat diet",
                    "template": "high-fat diet",
                    "type": "plus-minus"
                },
                {
                    "text": "dental exam (past 6 months)",
                    "template": "dental exam (past 6 months)",
                    "type": "plus-minus"
                },
                {
                    "text": "regular seatbelt use",
                    "template": "regular seatbelt use",
                    "type": "plus-minus"
                },
                {
                    "text": "smoke detectors in home",
                    "template": "smoke detectors in home",
                    "type": "plus-minus"
                },
                {
                    "text": "firearms in home",
                    "template": "firearms in home",
                    "type": "plus-minus"
                },
                {
                    "text": "abuse concerns (describe)",
                    "template": "(+) abuse, {text}",
                    "type": "alpha"
                },
                {
                    "text": "alcohol use >1 drink\/day",
                    "template": "alcohol use >1 drink\/day",
                    "type": "plus-minus"
                },
                {
                    "text": "alcohol use (describe)",
                    "template": "(+) alcohol, {text}",
                    "type": "alpha"
                },
                {
                    "text": "illicit drug use",
                    "template": "illicit drug use",
                    "type": "plus-minus"
                },
                {
                    "text": "illicit drug use (describe)",
                    "template": "(+) illicit drug, {text}",
                    "type": "alpha"
                },
                {
                    "text": "other lifestyle\/exposure (specify)",
                    "template": "{text}",
                    "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": "Family Hx specific to visit",
            "template": "Family history includes {children}.",
            "children": [
                {
                    "text": "cardiovascular disease",
                    "template": "cardiovascular disease",
                    "type": "plus-minus"
                },
                {
                    "text": "premature CAD, male relative",
                    "template": "MI and\/or sudden death in father\/male relative at <55 yo",
                    "type": "plus-minus"
                },
                {
                    "text": "premature CAD, female relative",
                    "template": "MI and\/or sudden death in mother\/female relative at <65 yo",
                    "type": "plus-minus"
                },
                {
                    "text": "stroke",
                    "template": "stroke",
                    "type": "plus-minus"
                },
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "hypercholesterolemia",
                    "template": "hypercholesterolemia",
                    "type": "plus-minus"
                },
                {
                    "text": "kidney disease",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "CKD stage 1",
                            "template": "CKD stage 1",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 2 (mild)",
                            "template": "CKD stage 2 (mild)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 3 (moderate)",
                            "template": "CKD stage 3 (moderate)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "CKD stage 4 (severe)",
                            "template": "CKD stage 4 (severe)",
                            "type": "plus-minus"
                        },
                        {
                            "text": "ESRD",
                            "template": "End Stage Renal Disease",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "diabetes",
                    "template": "diabetes",
                    "type": "plus-minus"
                },
                {
                    "text": "osteoporosis",
                    "template": "osteoporosis",
                    "type": "plus-minus"
                },
                {
                    "text": "breast cancer immediate relatives",
                    "template": "breast cancer in immediate relatives",
                    "type": "plus-minus"
                },
                {
                    "text": "ovarian cancer",
                    "template": "ovarian cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "colon cancer",
                    "template": "colon cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "prostate cancer",
                    "template": "prostate cancer",
                    "type": "plus-minus"
                },
                {
                    "text": "family hx of breast cancer (describe)",
                    "template": "(+)family hx of breast cancer, {text}",
                    "type": "alpha"
                },
                {
                    "text": "family hx of ovarian cancer (describe)",
                    "template": "(+)family hx of ovarian cancer, {text}",
                    "type": "alpha"
                },
                {
                    "text": "family hx of intestinal cancer (describe)",
                    "template": "(+) family hx of intestinal cancer, {text}",
                    "type": "alpha"
                },
                {
                    "text": "other family Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Immunization status",
            "template": "Immunization status: {children}.",
            "children": [
                {
                    "text": "up to date",
                    "template": "immunizations up to date"
                },
                {
                    "text": "see record for vaccine hx",
                    "template": "see immunization record for vaccine history"
                },
                {
                    "text": "HPV immunization",
                    "template": "HPV immunization",
                    "type": "plus-minus"
                },
                {
                    "text": "influenza immunization this season",
                    "template": "influenza immunization this season",
                    "type": "plus-minus"
                },
                {
                    "text": "not performed due to",
                    "template": "immunizations not performed due to",
                    "children": [
                        {
                            "text": "contrication",
                            "template": "contrication"
                        },
                        {
                            "text": "compromised condition",
                            "template": "compromised condition"
                        },
                        {
                            "text": "acute illness",
                            "template": "acute illness"
                        },
                        {
                            "text": "chronic illness",
                            "template": "chronic illness"
                        },
                        {
                            "text": "allergy of vaccine or component",
                            "template": "allergy of vaccine or component"
                        },
                        {
                            "text": "religious belief or group pressure",
                            "template": "religious belief or group pressure"
                        },
                        {
                            "text": "patient refusal",
                            "template": "patient refusal"
                        },
                        {
                            "text": "parent\/caregiver refusal",
                            "template": "parent\/caregiver refusal"
                        }
                    ]
                },
                {
                    "text": "other immunizations (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}