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.
Patient: Good afternoon, doctor.
Doctor: You're forty four, correct?
Patient: Yes sir.
Doctor: Great, what seems to be the problem today, sir?
Patient: Well, doctor, I've had lower back pain for a while now.
Doctor: Does the pain go into your legs?
Patient: Yeah, I have pain in my right thigh too.
Doctor: Is there an injury associated with this pain?
Patient: Yes, I had an incident back in nineteen ninety four.
Doctor: Do you have any paperwork or medical records from the initial injury?
Patient: No sir, I don't have those today.
Doctor: What do you do for a living, sir?
Patient: Right now, I work at Taco Bell. I have a workers comp claim open.
Doctor: Your pain came back while working there, correct?
Patient: Yes, that's correct.
Doctor: Do you remember when your last appointment here was?
Patient: Um, yes, it was on April twelfth two thousand five.
Doctor: With ten being the worst pain imaginable, what was your pain out of ten at your last visit?
Patient: Um, I'd say it was an eight out of ten.
Doctor: Have you taken any medicine for this?
Patient: Um, I had a Medrol Dosepak prescribed at my last visit.
Doctor: How did your pain respond to the Dosepak?
Patient: It took it down to about a four or five out of ten.
Doctor: Can you point to me where the pain is, sir?
Patient: Yes, it's right here.
Doctor: This band right here?
Patient: Yeah, that's the spot.
Doctor: Okay, this is between your L four and sacrum. How would you describe your right leg pain?
Patient: I'd say it's intermittent and minimal now, it's not always there.
Doctor: Have you ever had back surgery?
Patient: Um, yes, I've had two laminectomies, one in nineteen ninety and the other was in ninety four. Wait, I also had a discectomy some time in between.
Doctor: Do you know where the focus was?
Patient: It was at L four L 5.
Doctor: Have you had any imaging done on the lower back?
Patient: Yes, I had an M R I on October eighteenth two thousand four. I have the report right here.
Doctor: Okay, this shows multi level degenerative changes, with facet involvement at L two L three, L three L four, and L five S1, with no neural impingement, which is good.
Patient: What does that mean, doctor?
Doctor: In summary, you have a significant amount of arthritis in the back.
Patient: Oh yeah, I had an M R myelogram as well, here's the report.
Doctor: Okay, this shows severe spinal stenosis at L three L four, but it may have been artifact.
Patient: What does that mean?
Doctor: This finding may be a misinterpretation.

assistant: The patient is a 44-year-old man who was seen for complaints of low back and right thigh pain. He attributes this to an incident in which he was injured in 1994. I do not have any paperwork authenticating his claim that there is an open claim. Most recently he was working at Taco Bell, when he had a recurrence of back pain, and he was seen in our clinic on 04/12/05. He rated pain of approximately 8/10 in severity. He took a Medrol Dosepak and states that his pain level has decreased to approximately 4-5/10. He still localizes it to a band between L4 and the sacrum. He initially had some right leg pain but states that this is minimal and intermittent at the present time. His back history is significant for two laminectomies and a discectomy performed from 1990 to 1994. The area of concern was L4-L5. The patient's MRI dated 10/18/04 showed multi-level degenerative changes, with facet involvement at L2-L3, L3-L4 and L5-S1. There was no neural impingement. He also had an MR myelogram, which showed severe stenosis at L3-L4, however it was qualified in that it may have been artifact, rather than a genuine finding.