I am just trying to make sure that I am getting this right. An associated sign and symptom must be a symptom that the patient has. I have seen this be counted as an associated sign for a symptom that the patient does not have." no reflux or strider ." Context should be what the patient was doing when the symptoms occured. The statement of "Patient walks 2 miles per day on the treadmill". I am thinking that this would not be context.