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.

Clinical note:
Symptoms: pain in front of lower leg and right hip, burning, shooting, aching, constant in nature, worsened with standing and walking, alleviated by sitting, resting, sleeping, and massage
Diagnosis: spondylolisthesis, L4-L5 stenosis, facet joint arthropathy, foraminal disc protrusion, severely degenerated disc at L3-L4
History of Patient: underwent L3-L4 decompression surgery, experienced pain in right L4 distribution post-surgery, referred for L4 selective nerve root block to assess candidacy for TLIF at L4-L5
Plan of Action: N/A