{
    "section": "subjective",
    "templateSet": "Well Child Visit, 1 Month",
    "templates": [
        {
            "text": "(Patient age, weeks",
            "template": "Patient is a {text} week old",
            "type": "number"
        },
        {
            "text": "Sex",
            "template": "{children}",
            "children": [
                {
                    "text": "male",
                    "template": "male"
                },
                {
                    "text": "female",
                    "template": "female"
                }
            ]
        },
        {
            "text": "Reason for visit)",
            "template": "{children}.",
            "children": [
                {
                    "text": "well infant visit\/no acute concerns",
                    "template": "brought in by caregiver for well infant visit. Caregiver reports that the infant is\n                                developing normally, and there are no acute concerns\n                            "
                },
                {
                    "text": "follow up from prior visit",
                    "template": "brought in by caregiver for follow up from prior visit"
                },
                {
                    "text": "follow up visit from hospital",
                    "template": "brought in by caregiver for follow up visit from hospital"
                },
                {
                    "text": "referred by hospital",
                    "template": "referred by hospital, accompanied by caregiver"
                },
                {
                    "text": "well visit with acute concerns",
                    "template": "brought in by caregiver for well infant visit. Caregiver reports concerns related to\n                                infant, including {text}\n                            ",
                    "type": "alpha"
                },
                {
                    "text": "other well visit (describe)",
                    "template": "brought in by caregiver for {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Birth History",
            "template": "Patient was born {children}.",
            "children": [
                {
                    "text": "gestational age at birth (weeks)",
                    "template": "at {text} weeks",
                    "type": "number"
                },
                {
                    "text": "type of birth",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "vaginal",
                            "template": "via vaginal birth"
                        },
                        {
                            "text": "c-section",
                            "template": "via c-section birth"
                        }
                    ]
                },
                {
                    "text": "APGAR score",
                    "template": "APGAR score of",
                    "children": [
                        {
                            "text": "0",
                            "template": "0"
                        },
                        {
                            "text": "1",
                            "template": "1"
                        },
                        {
                            "text": "2",
                            "template": "2"
                        },
                        {
                            "text": "3",
                            "template": "3"
                        },
                        {
                            "text": "4",
                            "template": "4"
                        },
                        {
                            "text": "5",
                            "template": "5"
                        },
                        {
                            "text": "6",
                            "template": "6"
                        },
                        {
                            "text": "7",
                            "template": "7"
                        },
                        {
                            "text": "8",
                            "template": "8"
                        },
                        {
                            "text": "9",
                            "template": "9"
                        },
                        {
                            "text": "10",
                            "template": "10"
                        }
                    ]
                },
                {
                    "text": "birth weight (kg)",
                    "template": "birth weight {text} kg",
                    "type": "number"
                },
                {
                    "text": "length (inches)",
                    "template": "{text} inches in length",
                    "type": "number"
                },
                {
                    "text": "infant blood type",
                    "template": "infant blood type",
                    "children": [
                        {
                            "text": "A",
                            "template": "A",
                            "type": "plus-minus"
                        },
                        {
                            "text": "B",
                            "template": "B",
                            "type": "plus-minus"
                        },
                        {
                            "text": "AB",
                            "template": "AB",
                            "type": "plus-minus"
                        },
                        {
                            "text": "O",
                            "template": "O",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "mother's blood type",
                    "template": "mother's blood type",
                    "children": [
                        {
                            "text": "A",
                            "template": "A",
                            "type": "plus-minus"
                        },
                        {
                            "text": "B",
                            "template": "B",
                            "type": "plus-minus"
                        },
                        {
                            "text": "AB",
                            "template": "AB",
                            "type": "plus-minus"
                        },
                        {
                            "text": "O",
                            "template": "O",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "RhoGAM",
                    "template": "RhoGAM",
                    "children": [
                        {
                            "text": "given",
                            "template": "injections was given"
                        },
                        {
                            "text": "not given",
                            "template": "injection was not given"
                        }
                    ]
                },
                {
                    "text": "Hep B",
                    "template": "Hep B",
                    "children": [
                        {
                            "text": "given",
                            "template": "injection was given"
                        },
                        {
                            "text": "not given",
                            "template": "injection was not given"
                        }
                    ]
                },
                {
                    "text": "other birth history (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Interval History",
            "template": "Patient's caregiver reports the presence\/absence of the following hx\/sx since the last visit:\n                        {children}.\n                    ",
            "children": [
                {
                    "text": "no complaints",
                    "template": "no complaints"
                },
                {
                    "text": "abdominal pain",
                    "template": "abdominal pain",
                    "type": "plus-minus"
                },
                {
                    "text": "congestion",
                    "template": "congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "ear pain",
                    "template": "ear pain",
                    "type": "plus-minus"
                },
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "sore throat",
                    "template": "sore throat",
                    "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": "other history\/sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "congestion",
                    "template": "congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "cough",
                    "template": "cough",
                    "type": "plus-minus"
                },
                {
                    "text": "crying",
                    "template": "crying",
                    "type": "plus-minus"
                },
                {
                    "text": "irritability",
                    "template": "irritability",
                    "type": "plus-minus"
                },
                {
                    "text": "lethargy",
                    "template": "lethargy",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal discharge",
                    "template": "nasal discharge",
                    "type": "plus-minus"
                },
                {
                    "text": "sneezing",
                    "template": "sneezing",
                    "type": "plus-minus"
                },
                {
                    "text": "rash",
                    "template": "rash",
                    "type": "plus-minus"
                },
                {
                    "text": "rhinorrhea",
                    "template": "rhinorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "other pertinent sx (describe)",
                    "template": "other symptoms: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Feeding",
            "template": "Feeding: {children}.",
            "children": [
                {
                    "text": "breastfeeding, minutes (#)",
                    "template": "breastfeeding {text} minutes",
                    "type": "number"
                },
                {
                    "text": "breastfeeding, hrs btwn feedings (#)",
                    "template": "every {text} hrs",
                    "type": "number"
                },
                {
                    "text": "vomiting related to breastfeeding",
                    "template": "vomiting related to breastfeeding is described as {text}",
                    "type": "alpha"
                },
                {
                    "text": "formula type (describe)",
                    "template": "formula type infant is currently taking: {text}",
                    "type": "alpha"
                },
                {
                    "text": "formula feeding, oz per feeding (#)",
                    "template": "{text} oz of formula",
                    "type": "number"
                },
                {
                    "text": "formula feeding, hrs btwn feedings (#)",
                    "template": "every {text} hrs",
                    "type": "number"
                },
                {
                    "text": "vomiting, formula feeding",
                    "template": "vomiting related to formula feeding is described as {text}",
                    "type": "alpha"
                },
                {
                    "text": "vitamins",
                    "template": "vitamins",
                    "type": "plus-minus"
                },
                {
                    "text": "vitamin type (specify)",
                    "template": "vitamin type: {text}",
                    "type": "alpha"
                },
                {
                    "text": "other feeding concerns (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Elimination",
            "template": "Elimination: {children}.",
            "children": [
                {
                    "text": "normal urination",
                    "template": "normal urination"
                },
                {
                    "text": "normal bowel movements",
                    "template": "normal bowel movements"
                },
                {
                    "text": "wet diapers in 24 hrs (#)",
                    "template": "{text} wet diapers per 24 hours",
                    "type": "number"
                },
                {
                    "text": "BMs in 24 hrs (#)",
                    "template": "{text} BMs per 24 hrs",
                    "type": "number"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "constipation",
                    "template": "constipation",
                    "type": "plus-minus"
                },
                {
                    "text": "color",
                    "template": "stool is {children}",
                    "children": [
                        {
                            "text": "brown",
                            "template": "brown"
                        },
                        {
                            "text": "black",
                            "template": "black"
                        },
                        {
                            "text": "tarry",
                            "template": "tarry"
                        },
                        {
                            "text": "dark red",
                            "template": "dark red"
                        },
                        {
                            "text": "blood-tinged",
                            "template": "blood-tinged"
                        },
                        {
                            "text": "bloody",
                            "template": "bloody"
                        },
                        {
                            "text": "pale",
                            "template": "pale"
                        },
                        {
                            "text": "yellow",
                            "template": "yellow"
                        },
                        {
                            "text": "tan",
                            "template": "tan"
                        },
                        {
                            "text": "green",
                            "template": "green"
                        },
                        {
                            "text": "white\/chalky",
                            "template": "white\/chalky"
                        }
                    ]
                },
                {
                    "text": "consistency",
                    "template": "{children} in consistency",
                    "children": [
                        {
                            "text": "dry, hard",
                            "template": "dry, hard"
                        },
                        {
                            "text": "soft",
                            "template": "soft"
                        },
                        {
                            "text": "lumpy",
                            "template": "lumpy"
                        },
                        {
                            "text": "smooth",
                            "template": "smooth"
                        },
                        {
                            "text": "formed",
                            "template": "formed"
                        },
                        {
                            "text": "mushy",
                            "template": "mushy"
                        },
                        {
                            "text": "liquid",
                            "template": "liquid"
                        },
                        {
                            "text": "thick",
                            "template": "thick"
                        },
                        {
                            "text": "loose",
                            "template": "loose"
                        },
                        {
                            "text": "watery",
                            "template": "watery"
                        },
                        {
                            "text": "mucus",
                            "template": "with mucus"
                        }
                    ]
                },
                {
                    "text": "caliber",
                    "template": "{children} caliber",
                    "children": [
                        {
                            "text": "small caliber",
                            "template": "small"
                        },
                        {
                            "text": "medium caliber",
                            "template": "medium"
                        },
                        {
                            "text": "large caliber",
                            "template": "large"
                        }
                    ]
                },
                {
                    "text": "volume",
                    "template": "{children} volume",
                    "children": [
                        {
                            "text": "small volume",
                            "template": "small"
                        },
                        {
                            "text": "medium volume",
                            "template": "medium"
                        },
                        {
                            "text": "large volume",
                            "template": "large"
                        }
                    ]
                },
                {
                    "text": "frequency (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "other elimination concerns (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Sleep",
            "template": "Sleep: {children}.",
            "children": [
                {
                    "text": "back to sleep positioning",
                    "template": "back to sleep positioning",
                    "type": "plus-minus"
                },
                {
                    "text": "regular sleep schedule",
                    "template": "regular sleep schedule",
                    "type": "plus-minus"
                },
                {
                    "text": "sleeps through the night",
                    "template": "sleeps through the night",
                    "type": "plus-minus"
                },
                {
                    "text": "sleep, hours per night (#)",
                    "template": "infant sleeps {text} hrs per night",
                    "type": "number"
                },
                {
                    "text": "duration between feedings at night (# hours)",
                    "template": "duration between feedings at night is {text} hours",
                    "type": "number"
                },
                {
                    "text": "naps per day (#)",
                    "template": "{text} naps per day",
                    "type": "number"
                },
                {
                    "text": "average length of naps (describe)",
                    "template": "the average length of naps are {text}",
                    "type": "alpha"
                },
                {
                    "text": "other sleep concerns (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Developmental milestones",
            "template": "Developmental Milestones: {children}.",
            "children": [
                {
                    "text": "moves head side to side (GM)",
                    "template": "moves head side to side",
                    "type": "plus-minus"
                },
                {
                    "text": "lifts shoulder while prone (GM)",
                    "template": "lifts shoulder while prone",
                    "type": "plus-minus"
                },
                {
                    "text": "regards face (PS)",
                    "template": "regards face",
                    "type": "plus-minus"
                },
                {
                    "text": "smiles responsively (PS)",
                    "template": "smiles responsively",
                    "type": "plus-minus"
                },
                {
                    "text": "responds to noise (L)",
                    "template": "responds to noise",
                    "type": "plus-minus"
                },
                {
                    "text": "cooing (L)",
                    "template": "cooing",
                    "type": "plus-minus"
                },
                {
                    "text": "searches for sound with eyes (L)",
                    "template": "searches for sound with eyes",
                    "type": "plus-minus"
                },
                {
                    "text": "tracks past midline (FM)",
                    "template": "tracks past midline",
                    "type": "plus-minus"
                },
                {
                    "text": "other milestones (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Home environment\/exposures",
            "template": "Home Environment\/Exposures: {children}.",
            "children": [
                {
                    "text": "pets in home",
                    "template": "pets in home",
                    "type": "plus-minus"
                },
                {
                    "text": "smoking exposure in home",
                    "template": "smoking exposure in home",
                    "type": "plus-minus"
                },
                {
                    "text": "car seat use",
                    "template": "car seat use",
                    "type": "plus-minus"
                },
                {
                    "text": "parental social support available",
                    "template": "parental social support available",
                    "type": "plus-minus"
                },
                {
                    "text": "parental psych support available",
                    "template": "parental psychological support available",
                    "type": "plus-minus"
                },
                {
                    "text": "maternal eval, post-partum depression",
                    "template": "maternal evaluation for post-partum depression: {text}",
                    "type": "alpha"
                },
                {
                    "text": "inhome caregivers (describe)",
                    "template": "who lives in home with infant: {text}",
                    "type": "alpha"
                },
                {
                    "text": "other environment\/exposures (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Family hx specific to visit",
            "template": "Family history includes: {children}.",
            "children": [
                {
                    "text": "mother's age at delivery",
                    "template": "maternal age at delivery was {text} years old",
                    "type": "number"
                },
                {
                    "text": "mother's pregnancy hx: gravida",
                    "template": "mother's pregnancy hx gravida",
                    "type": "number"
                },
                {
                    "text": "mother's pregnancy hx: parity",
                    "template": "parity",
                    "type": "number"
                },
                {
                    "text": "prenatal care began",
                    "template": "prenatal care began in the {children}",
                    "children": [
                        {
                            "text": "no prenatal care",
                            "template": "no prenatal care"
                        },
                        {
                            "text": "1st trimester",
                            "template": "1st trimester"
                        },
                        {
                            "text": "2nd trimester",
                            "template": "2nd trimester"
                        },
                        {
                            "text": "3rd trimester",
                            "template": "3rd trimester"
                        }
                    ]
                },
                {
                    "text": "prenatal vitamins",
                    "template": "prenatal vitamins",
                    "type": "plus-minus"
                },
                {
                    "text": "infant hospital stay post delivery (days)",
                    "template": "infant's length of hospital stay after delivery was {text} days",
                    "type": "number"
                },
                {
                    "text": "maternal illness during pregnancy",
                    "template": "maternal illness during pregnancy",
                    "type": "plus-minus"
                },
                {
                    "text": "maternal illness during lactation",
                    "template": "maternal illness during lactation",
                    "type": "plus-minus"
                },
                {
                    "text": "maternal med use in pregnancy",
                    "template": "maternal med use in pregnancy",
                    "type": "plus-minus"
                },
                {
                    "text": "maternal med use in lactation",
                    "template": "maternal med use in lactation",
                    "type": "plus-minus"
                },
                {
                    "text": "allergy",
                    "template": "allergy",
                    "type": "plus-minus"
                },
                {
                    "text": "asthma",
                    "template": "asthma",
                    "type": "plus-minus"
                },
                {
                    "text": "congenital heart disease",
                    "template": "congenital heart disease",
                    "type": "plus-minus"
                },
                {
                    "text": "sudden death",
                    "template": "sudden death",
                    "type": "plus-minus"
                },
                {
                    "text": "childhood death",
                    "template": "childhood death",
                    "type": "plus-minus"
                },
                {
                    "text": "other family hx (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Immunizations\/Screenings",
            "template": "Immunizations\/Screenings: {children}.",
            "children": [
                {
                    "text": "vaccines",
                    "template": "{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": "not performed, compromised condition",
                            "template": "immunization not performed due to compromised condition"
                        },
                        {
                            "text": "not performed, acute illness",
                            "template": "immunization not performed due to acute illness"
                        },
                        {
                            "text": "not performed, chronic illness",
                            "template": "immunization not performed due to chronic illness"
                        },
                        {
                            "text": "not performed, allergy vaccine\/component",
                            "template": "immunization not performed due to allergy of vaccine or component"
                        },
                        {
                            "text": "not performed, religious belief\/group pressure",
                            "template": "immunization not performed due to religious belief or group pressure"
                        },
                        {
                            "text": "patient refusal",
                            "template": "patient refusal of immunization"
                        },
                        {
                            "text": "parent\/caregiver refusal",
                            "template": "parent\/caregiver refusal of immunization"
                        }
                    ]
                },
                {
                    "text": "immunizations comments (describe)",
                    "template": "immunization comments: {text}",
                    "type": "alpha"
                },
                {
                    "text": "hearing test",
                    "template": "newborn hearing test {children}",
                    "children": [
                        {
                            "text": "passed",
                            "template": "passed"
                        },
                        {
                            "text": "failed",
                            "template": "failed"
                        },
                        {
                            "text": "not done",
                            "template": "not done"
                        }
                    ]
                },
                {
                    "text": "hearing test comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "screening: newborn",
                    "template": "newborn screening",
                    "children": [
                        {
                            "text": "normal",
                            "template": "normal"
                        },
                        {
                            "text": "abnormal",
                            "template": "abnormal"
                        },
                        {
                            "text": "not done",
                            "template": "not done"
                        },
                        {
                            "text": "completed, awaiting results",
                            "template": "completed and awaiting results"
                        }
                    ]
                },
                {
                    "text": "screening: metabolic",
                    "template": "metabolic screening {children}",
                    "children": [
                        {
                            "text": "normal",
                            "template": "results normal"
                        },
                        {
                            "text": "abnormal",
                            "template": "results abnormal"
                        },
                        {
                            "text": "not done",
                            "template": "not done"
                        },
                        {
                            "text": "completed, awaiting results",
                            "template": "completed and awaiting results"
                        }
                    ]
                },
                {
                    "text": "jaundice screen results (describe)",
                    "template": "jaundice screen results: {text}",
                    "type": "alpha"
                },
                {
                    "text": "screening comments (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}