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: Hello, miss X Y Z. Dr. X and I will go over your report with you to make sure everything is correct. Then, I will ask you a few questions.
Patient: Sounds good to me.
Doctor_2: Hi, ma'am. Could you confirm your age for me, please?
Patient: I'm seventy six years old. I'm also a resident of A S D F if that matters.
Doctor_2: Thank you, ma'am.
Doctor: Doctor A B C requested for you to see us, correct?
Patient: That's correct.
Doctor: Perfect. Doctor X, could you go over her previous diagnoses?
Doctor_2: She is diagnosed with hyperlipidemia, hypertension, and atherosclerotic cerebrovascular disease. Is this all correct, ma'am?
Patient: Sounds about right.
Doctor: I see she underwent a procedure. What was it, Doctor X?
Doctor_2: She underwent a decompression for L three and L four. Did Doctor Stanley Gertzbein perform this procedure for your back?
Patient: He did. He also did surgery on my lower legs.
Doctor_2: Thank you for confirming.
Doctor: I see after the surgery, you had some pain in your right L four distribution, correct?
Patient: That's correct.
Doctor: Doctor X, did the M R I report of the outside lumbar come in?
Doctor_2: It did. We also have a report of a lumbar C T myelogram, but no films came.
Doctor: What does the C T myelogram say?
Doctor_2: It says she has spondylolisthesis and L four and L 5 stenosis with right posterior surgical fusion changes at both levels.
Doctor: I see. There are some notes from Doctor Reitman. What does it say?
Doctor_2: It looks like she is being sent for an L four selective nerve root block to rule out if she would be a candidate for a T L I F at L four and L 5.
Doctor: I see. Could you review the M R I film as well?
Doctor_2: The M R I reveal a grade two L four anterior spondylolisthesis without major canal stenosis. She does, however, have facet joint disease at this level and dorsal postoperative changes. She also has a foraminal disc protrusion on the right and a severely degenerated disc at L three and L four.
Doctor: Thank you for that. So, miss. Where are you feeling pain today?
Patient: I feel it in the font of my lower leg and right hip.
Doctor: What kind of pain are you feeling?
Patient: I told Doctor X about it. He could let you know.
Doctor_2: She claimed she had a burning, shooting, aching, and constant pain in nature.
Doctor: I see. Is it worse when you do certain activities?
Patient: Yes. When I walk and stand.
Doctor: Are you able to walk at all?
Patient: I can walk around a block before it gets to the point where I get weak.
Doctor: When does it feel better?
Patient: I feel more comfortable when I'm resting, sitting, sleeping, or getting a massage.
Doctor: From a scale of zero to ten, with ten being the worst pain, how would you rate the pain on average?
Patient: I'd say like a nine.
Doctor: That's the intensity on a daily level, correct?
Patient: Yeah, that's correct.
Doctor: What's the lowest pain you've ever felt?
Patient: I think it was a five.
Doctor: I see. Doctor X, did you ask her the series of questions about bowel function?
Doctor_2: I did. She denied any bowel or bladder dysfunction, saddle area hypoesthesia, numbness, tingling, weakness or Valsalva related exacerbation.
Doctor: Great. Have you taken any medication recently?
Patient: Uh. I think it starts with a T.
Doctor_2: It states here you took Tylenol, correct?
Patient: That's correct.

assistant: Ms. XYZ is a 76-year-old resident of ASDF. She is seen at the request of Dr. ABC. She carries a diagnosis of hyperlipidemia, hypertension, and atherosclerotic cerebrovascular disease. She underwent an L3-4 decompression in Month DD, YYYY by Dr. Stanley Gertzbein for back and bilateral lower extremity pain. Shortly after surgery, she began having pain in the right L4 distribution and is seen today with an outside lumbar MRI only. I have a report of a lumbar CT myelogram as well, but no films. She has apparently spondylolisthesis and L4-5 stenosis with right posterior surgical fusion changes evident at both levels. According to Dr. Reitman's notes, she is being sent for an L4 selective nerve root block to rule out whether or not she would be a candidate for a TLIF at L4-5. Her MRI films are reviewed. These reveal grade 2 L4 anterior spondylolisthesis without significant canal stenosis, though she has facet joint arthropathy at this level and dorsal postoperative changes. She has a foraminal disc protrusion on the right, as well as a severely degenerated disc at L3-4. The patient complains essentially of pain along the anterior tibia and along the right hip, which his burning, shooting, aching and constant in nature. It is worse with standing and walking. She can walk about a block before her symptoms become debilitating. She is more comfortable in recumbency. She denies bowel or bladder dysfunction, saddle area hypoesthesia, numbness, tingling, weakness or Valsalva related exacerbation. She rates her pain as 9/10 in average and her daily level of intensity and 5/10 for her least level of pain. Alleviating factors include sitting, recumbency, sleeping, and massage. She treats her pain with Tylenol currently.