{
    "section": "subjective",
    "templateSet": "Menopause",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "Patient presents for {children}.",
            "children": [
                {
                    "text": "menopausal sx evaluation",
                    "template": "evaluation of menopausal symptoms"
                },
                {
                    "text": "menopausal status assessment",
                    "template": "assessment of menopausal status"
                },
                {
                    "text": "annual gynecological visit",
                    "template": "annual gynecological visit"
                },
                {
                    "text": "well visit, no acute concerns",
                    "template": "well visit, no acute concerns"
                },
                {
                    "text": "Pap smear visit",
                    "template": "Pap smear visit"
                },
                {
                    "text": "concerns (specify)",
                    "template": "the following concerns: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Menopausal symptoms",
            "template": "Patient reports {children}.",
            "children": [
                {
                    "text": "no complaints",
                    "template": "Patient has no complaints."
                },
                {
                    "text": "symptom onset",
                    "template": "symptoms began {children}",
                    "children": [
                        {
                            "text": "in the past few weeks",
                            "template": "in the past few weeks"
                        },
                        {
                            "text": "in the past few months",
                            "template": "in the past few months"
                        },
                        {
                            "text": "in the past 12 months",
                            "template": "in the past 12 months"
                        },
                        {
                            "text": "over the past few years",
                            "template": "over the past few years"
                        },
                        {
                            "text": "over many years",
                            "template": "many years ago"
                        }
                    ]
                },
                {
                    "text": "hot flashes\/general menopause 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": "weight gain",
                            "template": "weight gain",
                            "type": "plus-minus"
                        },
                        {
                            "text": "weight loss",
                            "template": "weight loss",
                            "type": "plus-minus"
                        },
                        {
                            "text": "migraine",
                            "template": "migraine",
                            "type": "plus-minus"
                        },
                        {
                            "text": "skin dryness",
                            "template": "skin dryness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "thinning hair",
                            "template": "thinning hair",
                            "type": "plus-minus"
                        },
                        {
                            "text": "facial wrinkles",
                            "template": "facial wrinkles",
                            "type": "plus-minus"
                        },
                        {
                            "text": "neck wrinkles",
                            "template": "neck wrinkles",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "breast sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no breast complaints",
                            "template": "no breast complaints"
                        },
                        {
                            "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": "sagging breasts",
                            "template": "sagging breasts",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "vaginal sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no vaginal symptoms",
                            "template": "no vaginal complaints noted"
                        },
                        {
                            "text": "vaginal dryness",
                            "template": "vaginal dryness",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dyspareunia",
                            "template": "dyspareunia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pain in vaginal area",
                            "template": "pain in vaginal area",
                            "type": "plus-minus"
                        },
                        {
                            "text": "increase in usual vaginal discharge",
                            "template": "increase in usual vaginal discharge",
                            "type": "plus-minus"
                        },
                        {
                            "text": "foul-smelling vaginal discharge",
                            "template": "foul-smelling vaginal discharge",
                            "type": "plus-minus"
                        },
                        {
                            "text": "thick vaginal discharge",
                            "template": "thick vaginal discharge"
                        },
                        {
                            "text": "no vaginal discharge",
                            "template": "none"
                        },
                        {
                            "text": "thin vaginal discharge",
                            "template": "thin vaginal discharge"
                        },
                        {
                            "text": "white vaginal discharge",
                            "template": "white vaginal discharge"
                        },
                        {
                            "text": "clear vaginal discharge",
                            "template": "clear vaginal discharge"
                        },
                        {
                            "text": "cloudy vaginal discharge",
                            "template": "cloudy vaginal discharge"
                        },
                        {
                            "text": "yellow vaginal discharge",
                            "template": "yellow vaginal discharge"
                        }
                    ]
                },
                {
                    "text": "incontinence sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "urinary incontinence",
                            "template": "urinary incontinence",
                            "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": "nocturnal need for urination",
                            "template": "nocturnal need for urination",
                            "type": "plus-minus"
                        },
                        {
                            "text": "fecal incontinence",
                            "template": "fecal incontinence",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "pain sx",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "pelvic pain related to menses",
                            "template": "pelvic pain related to menses",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pelvic pain unrelated to menses",
                            "template": "pelvic pain unrelated to menses",
                            "type": "plus-minus"
                        },
                        {
                            "text": "premenstrual pelvic discomfort",
                            "template": "premenstrual pelvic discomfort",
                            "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": "migraine",
                            "template": "migraine",
                            "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": "Menses\/LMP\/Bleeding",
            "template": "Patient reports {children}.",
            "children": [
                {
                    "text": "no menstrual complaints",
                    "template": "Patient has no menstrual complaints."
                },
                {
                    "text": "menstrual and other bleeding",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no current menses",
                            "template": "no current menses"
                        },
                        {
                            "text": "skipping of cycles",
                            "template": "skipping of cycles",
                            "type": "plus-minus"
                        },
                        {
                            "text": "heavy menses",
                            "template": "heavy menses",
                            "type": "plus-minus"
                        },
                        {
                            "text": "heavy bleeding with clots",
                            "template": "heavy bleeding with clots",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding between periods",
                            "template": "bleeding between periods",
                            "type": "plus-minus"
                        },
                        {
                            "text": "increased bleeding duration",
                            "template": "increased bleeding duration",
                            "type": "plus-minus"
                        },
                        {
                            "text": "new bleeding after cessation of menses",
                            "template": "new bleeding after cessation of menses",
                            "type": "plus-minus"
                        },
                        {
                            "text": "significant pain w\/ menses",
                            "template": "significant pain w\/ menses",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bleeding after intercourse",
                            "template": "bleeding after intercourse",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "frequency of menses",
                    "template": "frequency of menses is {children}",
                    "children": [
                        {
                            "text": "regular cycles",
                            "template": "regular cycles"
                        },
                        {
                            "text": "irregular cycles",
                            "template": "irregular cycles"
                        },
                        {
                            "text": "monthly",
                            "template": "monthly"
                        },
                        {
                            "text": "monthly w\/ skipped cycles",
                            "template": "monthly with skipped cycles"
                        },
                        {
                            "text": "monthly w\/ some extra cycles",
                            "template": "monthly with some extra cycles"
                        },
                        {
                            "text": "every 2 weeks",
                            "template": "every 2 weeks"
                        },
                        {
                            "text": "every 3 weeks",
                            "template": "every 3 weeks"
                        },
                        {
                            "text": "every 5 weeks",
                            "template": "every 5 weeks"
                        },
                        {
                            "text": "every 6 weeks",
                            "template": "every 6 weeks"
                        },
                        {
                            "text": "every 8 weeks",
                            "template": "every 8 weeks"
                        },
                        {
                            "text": "every few months",
                            "template": "every few months"
                        },
                        {
                            "text": "no discernable pattern noted",
                            "template": "no discernable pattern noted"
                        },
                        {
                            "text": "postmenopausal",
                            "template": "postmenopausal"
                        }
                    ]
                },
                {
                    "text": "bleeding duration per cycle (specify days)",
                    "template": "bleeding duration per cycle is {text} days",
                    "type": "number"
                },
                {
                    "text": "age at menopause (specify)",
                    "template": "menopause at {text} years old",
                    "type": "number"
                },
                {
                    "text": "LMP began (specify date)",
                    "template": "last menses began {text}",
                    "type": "date"
                },
                {
                    "text": "LMP (describe)",
                    "template": "last menses: {text}",
                    "type": "alpha"
                },
                {
                    "text": "LMP >1 year ago",
                    "template": "last menses was over a year ago"
                },
                {
                    "text": "PMS symptoms",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "cramping premenstrually",
                            "template": "cramping premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pelvic discomfort premenstrually",
                            "template": "pelvic discomfort premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "breast tenderness premenstrually",
                            "template": "breast tenderness premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "weight gain premenstrually",
                            "template": "weight gain premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "irritability premenstrually",
                            "template": "irritability premenstrually",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bloating premenstrually",
                            "template": "bloating premenstrually",
                            "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"
                        }
                    ]
                },
                {
                    "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": "no sexual complaints noted",
                    "template": "no sexual complaints noted"
                },
                {
                    "text": "sexual symptoms",
                    "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": ">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": "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": "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": "abuse concerns (describe)",
                    "template": "abuse concerns: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "OB\/Gyn Hx specific to visit",
            "template": "OB\/Gyn history includes {children}.",
            "children": [
                {
                    "text": "Gravida\/Para\/Abortus",
                    "template": "G\/P\/A {text}",
                    "type": "alpha"
                },
                {
                    "text": "hx cervicitis",
                    "template": "hx cervicitis",
                    "type": "plus-minus"
                },
                {
                    "text": "hx STD",
                    "template": "hx STD",
                    "type": "plus-minus"
                },
                {
                    "text": "menopausal",
                    "template": "menopausal",
                    "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, {text}",
                    "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": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "abdominal aortic aneurysm",
                    "template": "abdominal aortic aneurysm",
                    "type": "plus-minus"
                },
                {
                    "text": "coronary artery disease",
                    "template": "coronary artery disease",
                    "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": "DVT",
                    "template": "DVT",
                    "type": "plus-minus"
                },
                {
                    "text": "HPV infection",
                    "template": "HPV infection",
                    "type": "plus-minus"
                },
                {
                    "text": "hyperlipidemia",
                    "template": "hyperlipidemia",
                    "type": "plus-minus"
                },
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "hypothyroidism",
                    "template": "hypothyroidism",
                    "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": "liver disease",
                    "template": "liver disease",
                    "type": "plus-minus"
                },
                {
                    "text": "migraines",
                    "template": "migraines",
                    "type": "plus-minus"
                },
                {
                    "text": "peripheral artery disease",
                    "template": "peripheral artery disease",
                    "type": "plus-minus"
                },
                {
                    "text": "symptomatic carotid artery disease",
                    "template": "symptomatic carotid artery disease",
                    "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": "hx {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": "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": "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": "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": "diabetes",
                    "template": "diabetes",
                    "type": "plus-minus"
                },
                {
                    "text": "osteoporosis",
                    "template": "osteoporosis",
                    "type": "plus-minus"
                },
                {
                    "text": "breast cancer in 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": "(+) {text}",
                    "type": "alpha"
                },
                {
                    "text": "Family Hx of ovarian cancer (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                },
                {
                    "text": "Family Hx of intestinal cancer (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                },
                {
                    "text": "Other family Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Immunization status",
            "template": "Immunization status: {children}",
            "children": [
                {
                    "text": "immunizations 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"
                }
            ]
        }
    ]
}