Doctor: The next patient we have is Miss Dey, we have been regularly following up with her for her hydrocephalus since two thousand and two.
Guest_clinician: Oh, okay.
Doctor: She also had anterior cervical corpectomy, we removed her front part of the vertebra followed by fusion from C three to C five in March two thousand and seven.
Guest_clinician: Oh wow!
Doctor: Yeah. We last saw her in March two thousand and eight at that time she was experiencing some head fullness and ringing in the ears, however we decided to leave her shunt setting at one point zero. 
Guest_clinician: Okay, then you asked her to follow up doctor X Y Z regarding her cervical spine M R I.
Doctor: Yes exactly! Let's go see her. Hello Miss Dey, how are you? This is my colleague doctor Jen, and she will be accompanying me today if that is okay with you? 
Patient: Of course, Hello doctors. 
Guest_clinician: Hi Miss Dey. 
Doctor: So, tell me what is going on? 
Patient: Well, last week I had some urine issue, like had to pee frequently. I had few episodes of urgency.
Doctor: Okay and how do you feel this week? 
Patient: This week it's much better I am not feeling like how I was feeling last week.
Doctor: Okay good. 
Patient: I feel no urgency or inconsistency and I am able to empty my bladder completely.
Doctor: That's good. 
Patient: However, I do leak some pee when I cough. I wear pads daily. 
Doctor: And did you notice any changes regarding your bladder, do you think it is better than before or worse since the last time I saw you?
Patient: I don't think it changed much, it feels almost the same. 
Doctor: Okay. Let's talk about your memory, any problem there, are you able to remember stuff and think about stuff?
Patient: Yes, all good there, no issues. 
Doctor: Any headache?
Patient: Nope!
Doctor: Any changes in your walk or balance?
Patient: Yes, I feel both have worsened. I am able to walk on uneven surface most of the time. But I feel I have become very slow. 
Doctor: And are you able to climb up and down the stairs? 
Patient: Yes. 
Doctor: Are you able to climb in and out of the car normally without any fuss?
Patient: Yes. 
Doctor: Are you using cane at this point of time?
Patient: No, no cane. 
Doctor: Okay good. Anything else you want to tell me?
Patient: Ah yes, in the beginning of May, I got a spell of severe cough and because of continuous coughing I think I developed pain in my hip which travels down to my legs.
Doctor: Oh okay, do you feel any tingling or numbness. 
Patient: Yes! I feel constant tingling sensation and a feeling that something is pinching my never. Sometimes it's just so painful. 
Doctor: Okay.
Patient: Often I feel like my legs have become like elastic. I feel this tingling sensation is the reason my walking has become slower. 
Doctor: Doctor Jen did you take the notes of what she said? 
Guest_clinician: I did. 
Doctor: Okay great, anything else Miss Dey? 
Patient: No, I think I told you everything. 
Doctor: Alright you take care. I will see you next time. 
Patient: Bye! 
Doctor: Bye. 
Guest_clinician: Take care Miss Dey, Bye!

Clinical note:
Symptoms: urinary frequency, leakage with coughing, buttock pain traveling down legs, tingling radiculopathy, feeling of legs being like elastic, worsened walking and balance
Diagnosis: hydrocephalus, anterior cervical corpectomy and fusion from C3 to C5
History of Patient: experiencing head fullness and ringing in the ears in March 2008, urged to follow up with Dr. XYZ regarding MRI of cervical spine
Plan of Action: N/A