{
    "section": "subjective",
    "templateSet": "Urinary Incontinence, Female",
    "templates": [
        {
            "text": "Reason for visit",
            "template": "Patient presents for {children}.",
            "children": [
                {
                    "text": "new onset symptom evaluation",
                    "template": "evaluation of new onset symptoms"
                },
                {
                    "text": "initial evaluation of incontinence symptoms",
                    "template": "initial evaluation of urinary incontinence symptoms"
                },
                {
                    "text": "follow-up incontinence evaluation",
                    "template": "follow-up urinary incontinence evaluation"
                },
                {
                    "text": "ongoing incontinence management",
                    "template": "ongoing urinary incontinence management"
                },
                {
                    "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": "chronic and ongoing condition",
                    "template": "is chronic and ongoing"
                },
                {
                    "text": "acutely worse (chronic condition)",
                    "template": "severity is reported to have acutely worsened"
                },
                {
                    "text": "progressive worsened",
                    "template": "is reported to have progressively worsened"
                },
                {
                    "text": "intermittent presence of symptoms",
                    "template": "symptoms are described as intermittently present"
                },
                {
                    "text": "Duration (hours)",
                    "template": "is reported as having been present for {text} hours",
                    "type": "number"
                },
                {
                    "text": "Duration (days)",
                    "template": "is reported as having been present for {text} days",
                    "type": "number"
                },
                {
                    "text": "Duration (weeks)",
                    "template": "is reported as having been present for {text} weeks",
                    "type": "number"
                },
                {
                    "text": "Duration (months)",
                    "template": "is reported as having been present for {text} months",
                    "type": "number"
                },
                {
                    "text": "Duration (years)",
                    "template": "is reported as having been present for {text} years",
                    "type": "number"
                },
                {
                    "text": "Duration (describe)",
                    "template": "is reported as having been present for {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Symptoms\/Functional impact",
            "template": "Patient reports the presence\/absence of the following Hx\/sx related to the current\n                        visit: {children}.\n                    ",
            "children": [
                {
                    "text": "no complaints",
                    "template": "Patient has no complaints."
                },
                {
                    "text": "incomplete bladder emptying",
                    "template": "incomplete bladder emptying",
                    "type": "plus-minus"
                },
                {
                    "text": "frequent need to urinate",
                    "template": "frequent need to urinate",
                    "type": "plus-minus"
                },
                {
                    "text": "difficulty postponing urination",
                    "template": "difficulty postponing urination",
                    "type": "plus-minus"
                },
                {
                    "text": "difficulty initiating urine stream",
                    "template": "difficulty initiating urine stream",
                    "type": "plus-minus"
                },
                {
                    "text": "nocturia",
                    "template": "nocturia",
                    "type": "plus-minus"
                },
                {
                    "text": "incontinence with cough\/sneeze",
                    "template": "incontinence with cough\/sneeze",
                    "type": "plus-minus"
                },
                {
                    "text": "Functional impact",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "no limitation of physical activity",
                            "template": "no limitation of physical activity"
                        },
                        {
                            "text": "slight limitation of physical activity",
                            "template": "slight limitation of physical activity"
                        },
                        {
                            "text": "marked limitation of physical activity",
                            "template": "marked limitation of physical activity"
                        },
                        {
                            "text": "unable to carry out any activity",
                            "template": "unable to carry out any activity without discomfort"
                        },
                        {
                            "text": "condition limits social activities",
                            "template": "condition limits social activities"
                        },
                        {
                            "text": "condition does not limit social activities",
                            "template": "condition does not limit social activities"
                        }
                    ]
                },
                {
                    "text": "Functional impact",
                    "template": "impaired functional status, described as {text}",
                    "type": "alpha"
                },
                {
                    "text": "Other sx describe",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Pertinent positives\/negatives",
            "template": "Pertinent positive\/negative symptoms include {children}.",
            "children": [
                {
                    "text": "fever",
                    "template": "fever",
                    "type": "plus-minus"
                },
                {
                    "text": "nausea",
                    "template": "nausea",
                    "type": "plus-minus"
                },
                {
                    "text": "abdominal pain",
                    "template": "abdominal pain",
                    "type": "plus-minus"
                },
                {
                    "text": "suprapubic pain",
                    "template": "suprapubic pain",
                    "type": "plus-minus"
                },
                {
                    "text": "abdominal distension",
                    "template": "abdominal distension",
                    "type": "plus-minus"
                },
                {
                    "text": "fecal incontinence",
                    "template": "fecal incontinence",
                    "type": "plus-minus"
                },
                {
                    "text": "back pain",
                    "template": "back pain",
                    "type": "plus-minus"
                },
                {
                    "text": "flank pain",
                    "template": "flank pain",
                    "type": "plus-minus"
                },
                {
                    "text": "dysuria",
                    "template": "dysuria",
                    "type": "plus-minus"
                },
                {
                    "text": "foul-smelling urine",
                    "template": "foul-smelling urine",
                    "type": "plus-minus"
                },
                {
                    "text": "cloudy urine",
                    "template": "cloudy urine",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary frequency",
                    "template": "urinary frequency",
                    "type": "plus-minus"
                },
                {
                    "text": "hematuria",
                    "template": "hematuria",
                    "type": "plus-minus"
                },
                {
                    "text": "symptoms with cough\/sneeze",
                    "template": "symptoms with cough\/sneeze",
                    "type": "plus-minus"
                },
                {
                    "text": "small amt urine loss per episode",
                    "template": "small amt urine loss per episode",
                    "type": "plus-minus"
                },
                {
                    "text": "large amt urine loss per episode",
                    "template": "large amt urine loss per episode",
                    "type": "plus-minus"
                },
                {
                    "text": "urinary dribbling",
                    "template": "urinary dribbling",
                    "type": "plus-minus"
                },
                {
                    "text": "difficulty attaining erection",
                    "template": "difficulty attaining erection",
                    "type": "plus-minus"
                },
                {
                    "text": "LE weakness",
                    "template": "LE weakness",
                    "type": "plus-minus"
                },
                {
                    "text": "LE numbness",
                    "template": "LE numbness",
                    "type": "plus-minus"
                },
                {
                    "text": "LE strength decreased",
                    "template": "LE strength decreased",
                    "type": "plus-minus"
                },
                {
                    "text": "LE paresthesias",
                    "template": "LE paresthesias",
                    "type": "plus-minus"
                },
                {
                    "text": "decreased perianal sensation",
                    "template": "decreased perianal sensation",
                    "type": "plus-minus"
                },
                {
                    "text": "Other pertinent sx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Exacerbating\/Alleviating factors",
            "template": "Patient reports that {children}.",
            "children": [
                {
                    "text": "Infection",
                    "template": "an infection {children}",
                    "children": [
                        {
                            "text": "worsens sx",
                            "template": "has worsened sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has had no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Weight gain",
                    "template": "weight gain {children}",
                    "children": [
                        {
                            "text": "worsens sx",
                            "template": "has worsened sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has had no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Coughing",
                    "template": "coughing {children}",
                    "children": [
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Sneezing",
                    "template": "sneezing {children}",
                    "children": [
                        {
                            "text": "worsens sx",
                            "template": "worsens sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been observed",
                            "template": "has not been observed"
                        }
                    ]
                },
                {
                    "text": "Oral contraceptives",
                    "template": "oral contraceptives {children}",
                    "children": [
                        {
                            "text": "improve sx",
                            "template": "improve sx"
                        },
                        {
                            "text": "worsen sx",
                            "template": "worsen sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been tried",
                            "template": "have not been tried"
                        }
                    ]
                },
                {
                    "text": "Timed voiding",
                    "template": "timed voiding {children}",
                    "children": [
                        {
                            "text": "improves sx",
                            "template": "improves sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "has no effect on sx"
                        },
                        {
                            "text": "has not been tried",
                            "template": "has not been tried"
                        }
                    ]
                },
                {
                    "text": "Kegel exercises",
                    "template": "Kegel exercises {children}",
                    "children": [
                        {
                            "text": "improve sx",
                            "template": "improve sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been tried",
                            "template": "have not been tried"
                        }
                    ]
                },
                {
                    "text": "Antispasmodic medications",
                    "template": "antispasmodic medications {children}",
                    "children": [
                        {
                            "text": "improve sx",
                            "template": "improve sx"
                        },
                        {
                            "text": "worsen sx",
                            "template": "worsen sx"
                        },
                        {
                            "text": "no effect on sx",
                            "template": "have no effect on sx"
                        },
                        {
                            "text": "have not been tried",
                            "template": "have not been tried"
                        }
                    ]
                },
                {
                    "text": "Other contributing factors (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Tx response\/Side effects",
            "template": "Treatment effects: {children}.",
            "children": [
                {
                    "text": "adherent to current tx",
                    "template": "adherent to current tx"
                },
                {
                    "text": "nonadherent to current tx",
                    "template": "nonadherent to current tx"
                },
                {
                    "text": "Reasons for nonadherence",
                    "template": "reasons for nonadherence include {children}",
                    "children": [
                        {
                            "text": "side effects",
                            "template": "side effects"
                        },
                        {
                            "text": "nausea",
                            "template": "nausea"
                        },
                        {
                            "text": "stomach upset",
                            "template": "stomach upset"
                        },
                        {
                            "text": "diarrhea",
                            "template": "diarrhea"
                        },
                        {
                            "text": "swallowing difficulty",
                            "template": "difficulty swallowing"
                        },
                        {
                            "text": "cost",
                            "template": "cost"
                        },
                        {
                            "text": "difficulty scheduling",
                            "template": "difficulty scheduling"
                        },
                        {
                            "text": "forgetfulness",
                            "template": "forgetfulness"
                        },
                        {
                            "text": "no perceived need for tx",
                            "template": "no perceived need for treatment"
                        }
                    ]
                },
                {
                    "text": "Nonadherence (describe)",
                    "template": "nonadherent to tx ({text})",
                    "type": "alpha"
                },
                {
                    "text": "Treatment response",
                    "template": "{children}",
                    "children": [
                        {
                            "text": "resolved with treatment",
                            "template": "resolved with treatment"
                        },
                        {
                            "text": "well-controlled on treatment",
                            "template": "well-controlled on treatment"
                        },
                        {
                            "text": "improving on treatment",
                            "template": "improving on treatment"
                        },
                        {
                            "text": "stable on treatment",
                            "template": "stable on treatment"
                        },
                        {
                            "text": "unchanged on treatment",
                            "template": "unchanged on treatment"
                        },
                        {
                            "text": "variable response to treatment",
                            "template": "variable response to treatment"
                        },
                        {
                            "text": "suboptimally-controlled on treatment",
                            "template": "suboptimally-controlled on treatment"
                        },
                        {
                            "text": "poorly-controlled on treatment",
                            "template": "poorly-controlled on treatment"
                        },
                        {
                            "text": "worsening on treatment",
                            "template": "worsening on treatment"
                        },
                        {
                            "text": "exacerbated despite treatment",
                            "template": "exacerbated despite treatment"
                        }
                    ]
                },
                {
                    "text": "Treatment response (describe)",
                    "template": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "no side effects noted",
                    "template": "no side effects noted"
                },
                {
                    "text": "Common side effects",
                    "template": "side effects include {children}",
                    "children": [
                        {
                            "text": "dry mouth",
                            "template": "dry mouth",
                            "type": "plus-minus"
                        },
                        {
                            "text": "constipation",
                            "template": "constipation",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dizziness\/vertigo",
                            "template": "dizziness\/vertigo",
                            "type": "plus-minus"
                        },
                        {
                            "text": "dry eyes",
                            "template": "dry eyes",
                            "type": "plus-minus"
                        },
                        {
                            "text": "blurred vision",
                            "template": "blurred vision",
                            "type": "plus-minus"
                        },
                        {
                            "text": "somnolence",
                            "template": "somnolence",
                            "type": "plus-minus"
                        },
                        {
                            "text": "insomnia",
                            "template": "insomnia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "nausea\/vomiting",
                            "template": "nausea\/vomiting",
                            "type": "plus-minus"
                        },
                        {
                            "text": "impotence",
                            "template": "impotence",
                            "type": "plus-minus"
                        },
                        {
                            "text": "decreased libido",
                            "template": "decreased libido",
                            "type": "plus-minus"
                        },
                        {
                            "text": "asthenia",
                            "template": "asthenia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "edema",
                            "template": "edema",
                            "type": "plus-minus"
                        },
                        {
                            "text": "tachycardia",
                            "template": "tachycardia",
                            "type": "plus-minus"
                        },
                        {
                            "text": "palpitations",
                            "template": "palpitations",
                            "type": "plus-minus"
                        }
                    ]
                },
                {
                    "text": "Side effects (describe)",
                    "template": "side effects: {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Medical Hx specific to visit",
            "template": "Medical history includes {children}.",
            "children": [
                {
                    "text": "recurrent UTI",
                    "template": "recurrent UTI",
                    "type": "plus-minus"
                },
                {
                    "text": "pyelonephritis",
                    "template": "pyelonephritis",
                    "type": "plus-minus"
                },
                {
                    "text": "nephrolithiasis",
                    "template": "nephrolithiasis",
                    "type": "plus-minus"
                },
                {
                    "text": "detrusor instability",
                    "template": "detrusor instability",
                    "type": "plus-minus"
                },
                {
                    "text": "indwelling urinary catheter",
                    "template": "indwelling urinary catheter",
                    "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": "immunosuppression",
                    "template": "immunosuppression",
                    "type": "plus-minus"
                },
                {
                    "text": "renal insufficiency",
                    "template": "renal insufficiency",
                    "type": "plus-minus"
                },
                {
                    "text": "multiple sclerosis",
                    "template": "multiple sclerosis",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx STD",
                    "template": "Hx STD",
                    "type": "plus-minus"
                },
                {
                    "text": "Hx pelvic surgery",
                    "template": "Hx pelvic surgery",
                    "type": "plus-minus"
                },
                {
                    "text": "back injury",
                    "template": "back injury",
                    "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": "{text}",
                    "type": "alpha"
                },
                {
                    "text": "Other medical Hx (describe)",
                    "template": "(+) {text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "OB\/Gyn Hx specific to visit",
            "template": "OB\/Gyn history includes {children}.",
            "children": [
                {
                    "text": "LMP (specify)",
                    "template": "LMP: {text}",
                    "type": "date"
                },
                {
                    "text": "pregnant",
                    "template": "pregnant",
                    "type": "plus-minus"
                },
                {
                    "text": "pregnancy history",
                    "template": "pregnancy history",
                    "type": "plus-minus"
                },
                {
                    "text": "vaginal delivery history",
                    "template": "vaginal delivery history",
                    "type": "plus-minus"
                },
                {
                    "text": "forceps delivery history",
                    "template": "forceps delivery history",
                    "type": "plus-minus"
                },
                {
                    "text": "Other OB\/Gyn Hx (describe)",
                    "template": "{text}",
                    "type": "alpha"
                }
            ]
        },
        {
            "text": "Lifestyle\/Environment factors",
            "template": "Lifestyle\/Environment factors include {children}.",
            "children": [
                {
                    "text": "alcohol use",
                    "template": "alcohol use",
                    "type": "plus-minus"
                },
                {
                    "text": "caffeine use",
                    "template": "caffeine use",
                    "type": "plus-minus"
                },
                {
                    "text": "cocaine use",
                    "template": "cocaine use",
                    "type": "plus-minus"
                },
                {
                    "text": "methamphetamine use",
                    "template": "methamphetamine use",
                    "type": "plus-minus"
                },
                {
                    "text": "high fat diet",
                    "template": "high fat diet",
                    "type": "plus-minus"
                },
                {
                    "text": "regular exercise",
                    "template": "regular exercise",
                    "type": "plus-minus"
                },
                {
                    "text": "nursing home resident",
                    "template": "nursing home resident",
                    "type": "plus-minus"
                },
                {
                    "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"
                }
            ]
        }
    ]
}