Patient presents with vaginal spotting.  Chief complaint is intermittent light vaginal bleeding, described as spotting.  Onset of vaginal spotting is documented as [Date of onset], with a duration of [Duration].  Patient reports [Frequency of spotting; e.g., daily, weekly, intermittent].  The character of the bleeding is described as [Character of bleeding; e.g., bright red, brown, pink].  Associated symptoms may include [Associated symptoms; e.g., abdominal pain, pelvic pain, cramping, lower back pain, vaginal discharge, itching, burning].  Patient denies [Pertinent negatives; e.g., fever, chills, nausea, vomiting, recent trauma].  Menstrual history includes [Menstrual history details; e.g., age at menarche, regularity, last menstrual period (LMP), typical flow, use of hormonal contraceptives, history of menopause, postmenopausal bleeding].  Relevant medical history includes [Relevant medical history; e.g., pregnancy, prior episodes of vaginal bleeding, sexually transmitted infections (STIs), gynecological procedures, hormonal imbalances, bleeding disorders, use of anticoagulants].  Physical examination reveals [Physical exam findings; e.g., normal external genitalia, no cervical lesions, uterus non-tender].  Differential diagnosis includes [Differential diagnoses; e.g., hormonal fluctuations, ovulation bleeding, implantation bleeding, breakthrough bleeding, cervical polyps, endometrial polyps, uterine fibroids, endometrial hyperplasia, cervical cancer, endometrial cancer].  Plan includes [Plan; e.g., pelvic exam, transvaginal ultrasound, endometrial biopsy, cervical cytology (Pap smear), complete blood count (CBC), coagulation studies, hormone level assessment, referral to gynecology].  Patient education provided regarding potential causes of vaginal spotting, importance of follow-up, and when to seek immediate medical attention.  Return to clinic scheduled for [Date of follow up].