{
  "template": true,
  "usage_notice": "Blank local worksheet. Do not submit private records or health data. Rightmark does not take health data yet (patient records, medical imaging or veterinary records), until a HIPAA program and vendor agreements are in place.",
  "record_id": null,
  "collection_name": null,
  "source_system": null,
  "source_period": null,
  "creator_or_rights_role": null,
  "rights_basis": null,
  "consent_or_notice_ref": null,
  "upstream_terms_ref": null,
  "processing_note": null,
  "exclusions": [],
  "evidence_refs": [],
  "verified_by_role": null,
  "verified_on": null,
  "status": "Needs evidence",
  "notes": null
}