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, ma'am. Before we begin, can you confirm your age for me, please?
Patient: Sure, I'm fifty six years old.
Doctor: Great, thank you. What seems to be the problem today?
Patient: Well, I have a history of systemic lupus erythematosus.
Doctor: How have you been treated for this in the past?
Patient: Um, I went to a rheumatologist about four months ago, I had discomfort in both of my hands.
Doctor: Which hand was worse?
Patient: My left was worse than my right at that time.
Doctor: Have you seen anyone else for this?
Patient: Um, I came in on October thirtieth two thousand seven. I was having the same problem.
Doctor: What did they do for you at that time?
Patient: They have me a trial of Elavil because they thought it was, um, ulnar or radial neuropathy.
Doctor: Did they give you any topical creams?
Patient: Yeah, they gave me a prescription for Zostrix but I couldn't fill it because of my insurance.
Doctor: I see, have your symptoms gotten worse since they began?
Patient: Yeah, especially here, at the base of my left hand, like around my wrist.
Doctor: Which fingers do you feel it in? If any?
Patient: Right here, doctor.
Doctor: Okay, these are your second, third, and fourth fingers. Do you have any other symptoms of note?
Patient: Um, actually yeah, I've been having some respiratory problems for the last three days or so.
Doctor: What symptoms have you been experiencing?
Patient: Um, I've had a dry cough and I feel like I've had a fever but I haven't taken my temperature.
Doctor: Have you had any night sweats or chills?
Patient: No, not that I can remember.
Doctor: Have you had any chest pain or discomfort?
Patient: No.
Doctor: What about shortness of breath, or G I problems?
Patient: Thankfully, no.

assistant: The patient is a 56-year-old female with a history of systemic lupus erythematosus, who was last seen in rheumatology clinic approximately 4 months ago for bilateral hand discomfort, left greater than right. The patient was seen on 10/30/07. She had the same complaint. She was given a trial of Elavil at bedtime because the thought was to see that represented ulnar or radial neuropathy. She was also given a prescription for Zostrix cream but was unable to get it filled because of insurance coverage. The patient reports some worsening of the symptoms especially involving at the dorsum of the left hand, and she points to the area that actually involves the dorsal aspect of the second, third, and fourth digits. The patient recently has developed what sounds like an upper respiratory problem with a nonproductive cough for 3 days, although she reports that she has had subjective fevers for the past 3 or 4 days, but has not actually taken the temperature. She has not had any night sweats or chills. She has had no recent problems with chest pain, chest discomfort, shortness of breath or problems with GU or GI complaints. She is returning today for routine followup evaluation.