Doctor: When was your injury, sir? 
Patient: Um, if I recall, it was on November twentieth two thousand eight. 
Doctor: What do you do for a living, sir? 
Patient: I work at the Purdy Correctional Facility, doctor. 
Doctor: How did you get hurt?
Patient: Well, an inmate broke some of the overhead sprinklers, and I slipped on all the water and I landed on the back of my head, and then onto my back. 
Doctor: Which side took most of the hit? 
Patient: It was mostly on my left side. 
Doctor: How were you after the fall? 
Patient: Well, I was pretty stunned, mostly. I didn't want to come in, but my employers asked me to just to be sure. 
Doctor: Who has evaluated you to date?
Patient: Um, I went to Gig Harbor Urgent Care, and then they sent me to Tacoma General Hospital. At Tacoma they said I have a whiplash and concussion.
Doctor: What did they do at the hospital? 
Patient: Um, they did a C T scan, and they found a dark spot on my brain. 
Doctor: What did they recommend about the spot? 
Patient: They said I should have another M R I and they diagnosed an, um, recurrent acoustic neuroma. 
Doctor: So, you've had this before? How did they know you had it? 
Patient: I used to see a chiropractor, and they suggested that I get a scan and that's how they found it before. 
Doctor: When was this? 
Patient: Um, it was in October of two thousand five. 
Doctor: Did you have surgery on this? 
Patient: Yes, I'm recovering now. 
Doctor: Are they still considering radiation?
Patient: Yes, it's under consideration but there's no final decision yet.
Doctor: Okay, what does the chiropractor do for you?
Patient: You know, the usual, adjustments and massages, stuff like that. 
Doctor: Has there been any improvement? 
Patient: Overall, my spine pain has improved a lot. 
Doctor: That's good. Okay, so after your fall, what other treatments did you have?
Patient: I went to Prompt Care in Bremerton, and saw Doctor X Y Z. She's an osteopathic doctor. 
Doctor: How did she treat you? 
Patient: She ordered an M R I of my neck, I have the report right here. 
Doctor: Okay, this shows some mild disc bulge at C four C five. Did she let you go back to work?
Patient: Yes, she released me back to full duty. I was doing fine after the neurosurgical treatment. 
Doctor: Do you have any other treatment planned?
Patient: Some radiation. 
Doctor: What else has she treated you for?
Patient: Oh, you know, just general aches and pains on my back and neck. I have been seeing her since two thousand and two.

Clinical note:
Symptoms: mild disc bulge at C4-C5, spine pain improvement
Diagnosis: whiplash, concussion, recurrent acoustic neuroma
History of Patient: injured on November 20, 2008, primarily landed on left side after slipping on water at work, diagnosed with whiplash and concussion at Gig Harbor urgent care and Tacoma General Hospital, brain CT showed dark spot, follow-up MRI showed recurrent acoustic neuroma, initial acoustic neuroma diagnosed in October 2005 after chiropractor suggested scan, receiving chiropractic adjustments and massages since 2002 for general aches and pains, treated by osteopathic physician for spine issues, full duty released after neurosurgical treatment, radiation planned
Plan of Action: undergoing neurosurgical treatment, radiation planned