{
    "section": "subjective",
    "templateSet": "COVID-19",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "The patient presents for {children}.",
            "children": [
                {
                    "text": "new-onset respiratory symptom evaluation",
                    "template": "evaluation of new-onset respiratory symptoms"
                },
                {
                    "text": "follow-up respiratory symptom evaluation",
                    "template": "follow-up respiratory symptom evaluation"
                },
                {
                    "text": "visit reason (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Onset\/Time course",
            "template": "Condition {children}.",
            "children": [
                {
                    "text": "acute onset (new condition)",
                    "template": "is reported to have developed acutely"
                },
                {
                    "text": "progressively worsened",
                    "template": "is reported to have progressively worsened"
                },
                {
                    "text": "Duration (days)",
                    "template": "has been present for {text} days",
                    "type": "number"
                },
                {
                    "text": "Duration (weeks)",
                    "template": "has been present for {text} weeks",
                    "type": "number"
                },
                {
                    "text": "Duration (months)",
                    "template": "has been been present for {text} months",
                    "type": "number"
                },
                {
                    "text": "Duration (years)",
                    "template": "has been present for {text} years",
                    "type": "number"
                },
                {
                    "text": "Duration (describe)",
                    "template": "has been present for {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Severity",
            "template": "Symptom severity is {children}.",
            "children": [
                {
                    "text": "mild",
                    "template": "mild"
                },
                {
                    "text": "moderate",
                    "template": "moderate"
                },
                {
                    "text": "severe",
                    "template": "severe"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Symptoms",
            "template": "Patient reports the presence\/absence of the following hx\/sx related to the current visit:\n                        {children}.\n                    ",
            "children": [
                {
                    "text": "fever present",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "subjective fever",
                    "template": "subjective fever",
                    "type": "plus-minus"
                },
                {
                    "text": "T max (Fahrenheit)",
                    "template": "T max {text} F",
                    "type": "number"
                },
                {
                    "text": "cough",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "cough present",
                            "template": "cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dry cough",
                            "template": "dry cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "productive cough",
                            "template": "productive cough",
                            "type": "plus-minus"
                        },
                        {
                            "text": "minimal sputum",
                            "template": "(+)minimal sputum"
                        },
                        {
                            "text": "moderate or copious sputum",
                            "template": "(+)moderate or copious sputum"
                        },
                        {
                            "text": "clear sputum",
                            "template": "clear sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "white sputum",
                            "template": "white sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "yellow sputum",
                            "template": "yellow sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "green sputum",
                            "template": "green sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "blood-tinged sputum",
                            "template": "blood-tinged sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "bloody sputum",
                            "template": "bloody sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "hemoptysis",
                            "template": "hemoptysis",
                            "type": "plus-minus"
                        },
                        {
                            "text": "plug-shaped sputum",
                            "template": "plug-shaped sputum",
                            "type": "plus-minus"
                        },
                        {
                            "text": "pain with cough",
                            "template": "pain with cough",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "shortness of breath",
                    "template": "shortness of breath",
                    "type": "plus-minus"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "sore throat",
                    "template": "sore throat",
                    "type": "plus-minus"
                },
                {
                    "text": "fatigue",
                    "template": "fatigue",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "malaise",
                    "template": "malaise",
                    "type": "plus-minus"
                },
                {
                    "text": "fatigue",
                    "template": "fatigue",
                    "type": "plus-minus"
                },
                {
                    "text": "rhinorrhea",
                    "template": "rhinorrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal congestion",
                    "template": "nasal congestion",
                    "type": "plus-minus"
                },
                {
                    "text": "nasal discharge",
                    "template": "nasal discharge",
                    "type": "plus-minus"
                },
                {
                    "text": "sneezing",
                    "template": "sneezing",
                    "type": "plus-minus"
                },
                {
                    "text": "itchy eyes",
                    "template": "itchy eyes",
                    "type": "plus-minus"
                },
                {
                    "text": "anosmia",
                    "template": "anosmia",
                    "type": "plus-minus"
                },
                {
                    "text": "dysgeusia",
                    "template": "dysgeusia",
                    "type": "plus-minus"
                },
                {
                    "text": "myalgia",
                    "template": "myalgia",
                    "type": "plus-minus"
                },
                {
                    "text": "anorexia",
                    "template": "anorexia",
                    "type": "plus-minus"
                },
                {
                    "text": "nausea",
                    "template": "nausea",
                    "type": "plus-minus"
                },
                {
                    "text": "vomiting",
                    "template": "vomiting",
                    "type": "plus-minus"
                },
                {
                    "text": "diarrhea",
                    "template": "diarrhea",
                    "type": "plus-minus"
                },
                {
                    "text": "headache",
                    "template": "headache",
                    "type": "plus-minus"
                },
                {
                    "text": "pleuritic pain",
                    "template": "pleuritic pain",
                    "type": "plus-minus"
                },
                {
                    "text": "other (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Previous history includes {children}.",
            "children": [
                {
                    "text": "allergy\/hayfever",
                    "template": "allergy\/hayfever",
                    "type": "plus-minus"
                },
                {
                    "text": "asthma",
                    "template": "asthma",
                    "type": "plus-minus"
                },
                {
                    "text": "COPD",
                    "template": "COPD",
                    "type": "plus-minus"
                },
                {
                    "text": "heart failure",
                    "template": "heart failure",
                    "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": "chronic kidney disease",
                    "template": "chronic kidney disease",
                    "type": "plus-minus"
                },
                {
                    "text": "hypertension",
                    "template": "hypertension",
                    "type": "plus-minus"
                },
                {
                    "text": "depression",
                    "template": "depression",
                    "type": "plus-minus"
                },
                {
                    "text": "anxiety disorder",
                    "template": "anxiety disorder",
                    "type": "plus-minus"
                },
                {
                    "text": "active cancer (specify type)",
                    "template": "(+)active cancer ({text})",
                    "type": "alpha"
                },
                {
                    "text": "current chemotherapy",
                    "template": "current chemotherapy",
                    "type": "plus-minus"
                },
                {
                    "text": "other immunosupp (specify)",
                    "template": "(+)other immunosuppression ({text})",
                    "type": "alpha"
                },
                {
                    "text": "other medical Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environment factors",
            "template": "Lifestyle\/Environment factors include: {children}.",
            "children": [
                {
                    "text": "recent travel (specify)",
                    "template": "(+) recent travel ({text})",
                    "type": "alpha"
                },
                {
                    "text": "travel\/residence in COVID-19 area",
                    "template": "travel\/residence in COVID-19-endemic area",
                    "type": "plus-minus"
                },
                {
                    "text": "exposed to COVID-19 case",
                    "template": "exposed to COVID-19 case",
                    "type": "plus-minus"
                },
                {
                    "text": "LTCF resident",
                    "template": "LTCF resident",
                    "type": "plus-minus"
                },
                {
                    "text": "occupation (describe)",
                    "template": "occupation is {text}",
                    "type": "alpha"
                },
                {
                    "text": "other lifestyle\/exposure (specify)",
                    "template": "other lifestyle\/exposure includes (+){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": "Immunizations",
            "template": "Immunization Hx: {children}.",
            "children": [
                {
                    "text": "flu vax received this season",
                    "template": "flu vax received this season",
                    "type": "plus-minus"
                },
                {
                    "text": "pneumococcal vaccine Hx",
                    "template": "pneumococcal vaccine Hx",
                    "type": "plus-minus"
                },
                {
                    "text": "meningococcal vaccine Hx",
                    "template": "meningococcal vaccine Hx",
                    "type": "plus-minus"
                },
                {
                    "text": "Pertussis vaccine",
                    "template": "pertussis vaccine is {children}",
                    "children": [
                        {
                            "text": "up to date",
                            "template": "up to date"
                        },
                        {
                            "text": "not up to date",
                            "template": "not up to date"
                        }
                    ]
                },
                {
                    "text": "Diphtheria vaccine",
                    "template": "diphtheria vaccine is {children}",
                    "children": [
                        {
                            "text": "up to date",
                            "template": "up to date"
                        },
                        {
                            "text": "not up to date",
                            "template": "not up to date"
                        }
                    ]
                },
                {
                    "text": "other immunizations (specify)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        }
    ]
}