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: Good afternoon, sir. Welcome in. Let's get started, how old are you?
Patient: Good afternoon, doctor. I'm fifty two years old.
Doctor: My nurse says that you're here for an independent evaluation, is that correct?
Patient: Yes sir, that is.
Doctor: Good, what do you do for a living?
Patient: Right now, I'm a temporary employee for A B C A B C, I've worked for A B C D, too.
Doctor: What do you do there?
Patient: Mainly, I handle the loading and unloading of furniture and appliances for people's houses.
Doctor: That's hard work. When did you get hurt?
Patient: It was about two and a half weeks ago now, back in October.
Doctor: Do you have a history of back problems, like before this injury?
Patient: Yeah, I've had back pain for a long time.
Doctor: What happened when you got hurt this time?
Patient: I was unloading one of the A B C eighteen wheelers, when I bent down to pick up some boxes, and I felt the pain.
Doctor: What kind of pain did you feel?
Patient: I felt a sharp pain in my lower back right away when I tried to lift those boxes.
Doctor: Does your pain go down your legs?
Patient: Yes, it goes into the right side of my butt, and then all the way down the outside of my right leg, like into the knee.
Doctor: How have your symptoms progressed since they began?
Patient: Doctor, they've only gotten worse.
Doctor: Do you have any pain in your left leg?
Patient: A little, not as bad as the right.
Doctor: What other symptoms are you having besides the pain down your leg?
Patient: The muscles in my butt are spazzing, and it's happening more and more.
Doctor: Have you seen another doctor for this?
Patient: Yes, I saw Doctor Z at first.
Doctor: What did they do for you?
Patient: He gave me some muscle relaxers, and some, um, Lidocaine patches.
Doctor: Did this help at all?
Patient: No, not at all.
Doctor: Who else have you seen?
Patient: I saw doctor X Y Z too, through worker's comp.
Doctor: When did you see them?
Patient: That was back in April.
Doctor: What did they recommend?
Patient: Um, he sent me for an M R I, and I have the report for that right here.
Doctor: Okay, this M R I report is basically negative, which is good. Did he give you any medications?
Patient: Yes, he gave me some opioids.
Doctor: Wow, that's strong stuff. What is your work status right now?
Patient: Doctor X Y Z put me on restricted duty status, doctor.
Doctor: I'm reading your notes from doctor X Y Z, he says he released you in June, and that you have reached maximum medical improvement.
Patient: He told me that, but I still have pain, so I went back to see him.
Doctor: When you went for follow up, did you still have that pain down your legs?
Patient: Yes, I did.
Doctor: What did doctor X Y Z recommend at that time?
Patient: He referred me to a Pain Clinic, and he recommended I have, um, epidural injections with doctor A B C.
Doctor: Did you have this done?
Patient: Yes, I did.
Doctor: Did this help at all?
Patient: No, it did absolutely nothing.
Doctor: Okay, so after that, what treatment did you have?
Patient: I had an M R I, um, E M G, and nerve conduction study with doctor A B C D.
Doctor: Do you have the results of that as well?
Patient: Yes, doctor, they're right here.
Doctor: Okay, sir, these tests are essentially normal, which is more good news. What aggravates your pain?
Patient: Well, anything like sitting for a long time. When I do that, I feel it in my legs.
Doctor: When you sit for a long time, is it in both legs?
Patient: It's really on my right.
Doctor: Are you able to sleep at night?
Patient: No, sir, I'm not able to sleep at all.
Doctor: Have you been able to return to work?
Patient: Well, I went back to work in June, after doctor X said I'd reached the maximum medical improvement we talked about.
Doctor: Finally, have you seen a chiropractor for this pain?
Patient: Yeah, I saw doctor X about eight or nine times.
Doctor: Did they do anything to help you feel better?
Patient: Really, no, it did not. I still have the pain down my legs today.

assistant: The patient is a 52-year-old male who is here for independent medical evaluation. The patient states that he works for ABC ABC as a temporary worker. He worked for ABCD too. The patient's main job was loading and unloading furniture and appliances for the home. The patient was approximately there for about two and a half weeks. Date of injury occurred back in October. The patient stating that he had history of previous back problems ongoing; however, he states that on this particular day back in October, he was unloading an 18-wheeler at ABC and he was bending down picking up boxes to unload and load. Unfortunately at this particular event, the patient had sharp pain in his lower back. Soon afterwards, he had radiating symptoms down his right buttock all the way down to the lateral part of his leg crossing his knee. This became progressively worse. He also states that some of his radiating pain went down to his left leg as well. He noticed increase in buttock spasm and also noticed spasm in his buttocks. He initially saw Dr. Z and was provided with some muscle relaxer and was given some pain patches or Lidoderm patch, I believe. The patient states that after this treatment, his symptoms still persisted. At this point, the patient later on was referred to Dr. XYZ through the workmen's comp and he was initially evaluated back in April. After the evaluation, the patient was sent for MRI, was provided with pain medications such as short-acting opioids. He was put on restricted duty. The MRI essentially came back negative, but the patient continued to have radiating symptoms down to his lower extremity and subsequently the patient was essentially released by Dr. XYZ in June with maximum medical improvement. Unfortunately, the patient continued to have persistence of back pain and radiating symptoms down to his leg and went back to see Dr. XYZ again, and at this point, the patient was provided with further medication management and sent for Pain Clinic referral. The patient also was recommended for nerve block at this point and the patient received epidural steroid injection by Dr. ABC without any significant relief. The patient also was sent for EMG and nerve conduction study, which was performed by Dr. ABCD and the MRI, EMG, and nerve conduction study came back essentially negative for radiculopathy, which was performed by Dr. ABCD. The patient states that he continues to have pain with extended sitting, he has radiating symptoms down to his lower extremity on the right side of his leg, increase in pain with stooping. He has difficulty sleeping at nighttime because of increase in pain. Ultimately, the patient was returned back to work in June, and deemed with maximum medical improvement back in June. The patient unfortunately still has significant degree of back pain with activities such as stooping and radicular symptoms down his right leg, worse than the left side. The patient also went to see Dr. X who is a chiropractic specialist and received eight or nine visits of chiropractic care without long-term relief in his overall radicular symptoms.