C09972078 / invoice 10000

Reviewer

Species:CANINE

Breed:Golden Retriever

Age (years):1

Diagnosis or signs:Follow up - otitis externa

Consult notes

<html><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><p><strong>Presenting Complaint</strong></p>
<ul>
<li>Revisit - 3 weeks post start of Osurnia</li>
</ul>
<p><strong>History</strong></p>
<ul>
<li>Right ear infection treated with Osurnia weekly for 2 applications</li>
<li>Follow-up visit one week after second Osurnia treatment</li>
<li>Mild discharge noted from both ears at home</li>
</ul>
<p><strong>Physical Examination</strong></p>
<ul>
<li>Temp: 38.4°C, HR: 98 bpm, RR: 18 bpm</li>
<li>MM: pink and moist, CRT: &lt;2 seconds</li>
<li>BCS: 5/9</li>
<li>Hydration: adequate</li>
<li>Mentation: BAR</li>
<li>Right ear: resolved infection, no cytologic evidence of infection</li>
<li>Left ear: 1+ cocci on cytology, mild discharge</li>
<li>Other systems: NAD</li>
</ul>
<p><strong>Problem List</strong></p>
<ul>
<li>Resolved right otitis externa (post-Osurnia treatment)</li>
<li>Left otitis externa with bacterial overgrowth (cocci)</li>
<li>Bilateral mild ceruminous discharge</li>
</ul>
<p><strong>Differentials</strong></p>
<ul>
<li>Primary bacterial otitis externa (cocci) - supported by cytology showing 1+ cocci in left ear</li>
<li>Secondary bacterial infection due to underlying allergic otitis - common in young Golden Retrievers, bilateral involvement suggests systemic cause</li>
<li>Ceruminous otitis with secondary bacterial colonization - mild discharge both ears, minimal inflammation currently</li>
<li>Residual infection from initial presentation - possible spread from right to left ear</li>
<li>Malassezia otitis - less likely given cocci identified on cytology rather than yeast</li>
</ul>
<p><strong>Diagnostics</strong></p>
<ul>
<li><strong>Comprehensive</strong>: Deep ear canal evaluation under sedation, culture and sensitivity if no response to empiric therapy, allergy workup (intradermal or serum testing) given breed and bilateral involvement, thyroid panel to rule out endocrinopathy</li>
<li><strong>Targeted</strong>: Repeat ear cytology left ear in 7 days, evaluate for erythema/inflammation to determine need for Osurnia</li>
<li><strong>Conservative</strong>: Monitor left ear at home with Epiotic cleaning, recheck if worsening</li>
</ul>
<p><strong>Treatment</strong></p>
<ul>
<li>Epiotic SIS ear cleaner for both ears - use 2-3 times weekly for maintenance cleaning</li>
<li>If left ear develops erythema or inflammation, initiate Osurnia (florfenicol 15.9 mg, terbinafine 14.8 mg, mometasone 4.4 mg per 1 mL dose) - apply 1 mL to affected ear, may repeat weekly for up to 2 additional doses</li>
<li>Monitor for head shaking, ear rubbing, odor, or discharge</li>
<li>Consider long-term maintenance cleaning given bilateral ceruminous discharge</li>
</ul>
<p><strong>Client Communication</strong></p>
<ul>
<li>Right ear infection has resolved completely with Osurnia treatment</li>
<li>Left ear showing early bacterial overgrowth but minimal inflammation currently</li>
<li>Home cleaning with Epiotic recommended for both ears to prevent recurrence</li>
<li>Monitor left ear closely - if becomes red, inflamed, or more painful, will need Osurnia treatment similar to right ear</li>
<li>Recheck in 7-14 days or sooner if left ear worsens</li>
<li>Prognosis excellent for resolution with treatment</li>
<li>Consider discussing allergy management long-term given breed predisposition and bilateral ear involvement in young dog</li>
</ul></html>

Animal clinical history (3 most recent)

2026-02-23T00:00:00Z 11:13:00

Doing well - Ow mentioned has improved since the last application of OsurniaApplied 2nd dose of OsurniaRevisit in 1 week for ear cytology

2026-02-16T00:00:00Z 11:31:00

H:Redness and inflammation of the right earEDDU normalNo other concerns at this stageE:MM Pink MoistCRT<2sLN WNLEyes NADEars:Right ear discharge ++Left ear normalCytology Yeast ++ in right ear and negative in left earA:Otitis externa right earP:Osurnia ear drops into the right earRevisit in 1 week for second dose (no consult fee/just osurnia)Revsit recommend 1 weeks post second dose of osurnia for another cytology of the right ear

2026-02-16T00:00:00Z 11:21:00

The intention of the following template is to clarify the minimum requirements for veterinary notes. This should not be used if it is a first claim as it will likely go on hold for more information required.GapOnly claim Insurance SummaryFirst Clinical Signs: redness and inflammation of the right earSummary: Shaking head, rubbing right ear; cleaning solution not helping muchDiagnosis: Otitis externa right earTreatment: osurnia applied into the right ear canal, revisit in 1 weeks for second dose

Previous claim history (4)

Date	Claim #	Diagnosis
2026-02-23	C09940074	OTITIS EXTERNA
2026-02-16	C09907594	OTITIS EXTERNA
2026-02-03	C09845452	DIETARY INDISCRETION - FOREIGN BODY INGESTION - PRESENTING COMPLAINT
2025-06-23	C8872674	VACCINATIONS OR HEALTH CHECKS

Line items(lines with upstream diagnosis are skipped by the model)

Line	tstarc	Amount	Date	Upstream diagnosis
10000	tstarc_consultation-revisit	59.00	2026-03-02	—
20000	tstarc_diagnostic_test_-_cytology	95.00	2026-03-02	—
30000	tstarc_ear_cleaner	53.07	2026-03-02	—

UPM+

DG01185OTITIS EXTERNADSTP_otitis_externa

Variant (sleepy_king)

OTITIS EXTERNA

DSTP_otitis_externa

Conf: 0.980

Threshold: 0.07

Above: ✓

Correct?

Yes No