system: You are a clinical documentation assistant. Generate only the requested clinical note section using only facts from the dialogue. Do not invent information. If the section is not supported by the dialogue, return N/A.

user: Section: GENHX

Dialogue:
Doctor: I hear someone has a birthday coming up, how old are you turning, ma'am?
Patient: I'll be ninety later this month, doctor.
Doctor: You're here for a follow up not very long after your first visit. What seems to be the problem today?
Patient: Well, actually, my high blood pressure and right arm symptoms are basically gone.
Doctor: Great, I saw your blood pressure reading for today, and it's much better. Are you taking the higher dose of Mavik we recommended?
Patient: No, I'm not taking that right now.
Doctor: How did you tolerate the higher dose?
Patient: I didn't feel well at all, so I just went back to the old dose.
Doctor: That was one M G per day, correct?
Patient: Yes, doctor. I do think I could have some white coat high blood pressure. Doctors' offices make me nervous.
Doctor: That does happen. Here, try this sample of Tarka, please.
Patient: What is this for, doctor?
Doctor: Well, since you're taking the Mavik plus verapamil, you can switch over to Tarka, which is the combined version of the two drugs.
Patient: I can't take these, doctor. They're too big.
Guest_family: Hello doctor, I'm her daughter. Just so you know, we check her blood pressure at home periodically and it's always similar to that reading.
Doctor: Good, so back to that right arm, how is that doing today?
Patient: Well, that pain is basically gone now, I think it had to do with that muscle problem back in my right shoulder blade.
Doctor: Did you have x rays taken today?
Patient: Yes, the tech brought me back right before you came in.
Doctor: Good, I have the images right here.
Patient: What do they show, doctor?
Doctor: Well, these x rays of the neck and right shoulder show some degenerative changes, and possibly some kind of rotator cuff injury.
Patient: What makes you think there's an injury?
Doctor: Well, look right here. The humeral head is pretty high in the glenoid in the right shoulder, but do you have any pain here?
Patient: No, none.
Doctor: Then we won't worry about it.
Patient: I am having this stomach pain though, doctor.
Doctor: How has this pain developed and progressed recently?
Patient: Well, it's improved somewhat with me not taking Aleve anymore.
Doctor: What medicines are you taking right now, then?
Patient: Right know, I'm just taking Tylenol as needed. That seems to be enough for me.
Doctor: Do you think this could be acid reflux, or heartburn?
Patient: No, but I take Tums, um, three times a day, and Mylanta at night. Oh yeah, I have these sores in my mouth, can you take a look?
Doctor: I see. How long have you worn dentures?
Patient: Oh I couldn't even tell you, it's been many, many years.
Doctor: Do they come and go, the sores?
Patient: Yes, one will come, then it'll heal up, then another.
Doctor: Okay, we'll keep an eye on it.
Patient: And doctor, since I've been taking the Lexapro, I have some tremors on basically my whole body, at least the upper body, like my torso and arms.
Doctor: It's hard to tell if you have a tremor today, ma'am, but do you think the Lexapro is helping otherwise?
Patient: Yes, we think so.

assistant: The patient is an 89-year-old lady. She actually turns 90 later this month, seen today for a short-term followup. Actually, the main reasons we are seeing her back so soon which are elevated blood pressure and her right arm symptoms are basically resolved. Blood pressure is better even though she is not currently on the higher dose Mavik likely recommended. She apparently did not feel well with the higher dose, so she just went back to her previous dose of 1 mg daily. She thinks, she also has an element of office hypertension. Also, since she is on Mavik plus verapamil, she could switch over to the combined drug Tarka. However, when we gave her samples of that she thought they were too big for her to swallow. Basically, she is just back on her previous blood pressure regimen. However, her blood pressure seems to be better today. Her daughter says that they do check it periodically and it is similar to today's reading. Her right arm symptoms are basically resolved and she attributed that to her muscle problem back in the right shoulder blade. We did do a C-spine and right shoulder x-ray and those just mainly showed some degenerative changes and possibly some rotator cuff injury with the humeral head quite high up in the glenoid in the right shoulder, but this does not seem to cause her any problems. She has some vague 'stomach problems', although apparently it is improved when she stopped Aleve and she does not have any more aches or pains off Aleve. She takes Tylenol p.r.n., which seems to be enough for her. She does not think she has any acid reflux symptoms or heartburn. She does take Tums t.i.d. and also Mylanta at night. She has had dentures for many, many years and just recently I guess in the last few months, although she was somewhat vague on this, she has had some sores in her mouth. They do heal up, but then she will get another one. She also thinks since she has been on the Lexapro, she has somewhat of a tremor of her basically whole body at least upper body including the torso and arms and had all of the daughters who I not noticed to speak of and it is certainly difficult to tell her today that she has much tremor. They do think the Lexapro has helped to some extent.