C09974838 / invoice 10000

Appointment Notes: wanting Apoquel repeat for skin (Written script)Primary complaint/relevant information:  Disease onset Progression and duration: Current Medications: None  Medical conditions: None  Appetite: goodEnergy Levels:  good Exercise/Exercise intolerance: none Vomiting:  noneDiarrhoea:   noneWeight loss/gain: Thirst: Urination: Coughing/Sneezing/Respiratory signs: Diet:  Flea/tick:  Worming: Indoor/outdoor: Toxin exposure: Travel history: Scratching, chewing, licking (Y)Red skin, rashes or hairloss (Y) Itchy eyes, ears or bottom (N) Ear discharge and/or smell (N)Flare up in spring/summer (Y) EXAMINATION: Demeanour: BAR MM: Pink, moist, CRT <2 Eyes: Clean and clear, normal eyelids, no erythema or discharge Ears: Minimal debris, no inflammation or odour Lymph nodes: Peripheral lymph nodes palpably normal Oral: No oral lesions or abnormalities detectedTeeth: Dental grade 0/4, normal occlusion. COHAT Level Estimated: (A, B, C, D, E) Cardiovascular: Normal heart sounds, no murmurs or arrhythmias detected, femoral pulses synchronous and normodynamic Respiratory: No nasal discharge, normal bronchovesicular lung sounds in all 4 quadrants, no coughing seen Abdomen: Soft and comfortable on palpation, no masses palpated, bladder unremarkable MSK: Normal gait no lameness. Normal ROM with no pain of all limbs. No pain on DV palpation of spine Integument: Signs of allergic dermatitis/atopyFace (Muzzle erythema, periocular hairloss) Feet (Erythema, saliva staining, brown discharge) Dorsum (Erythema, papules, hairloss) Ventrum (Erythema, papules, hairloss) Perineum (Erythema, papules, hairloss) Neurological: Normal mentation, no ataxia or CP deficits observed. Full exam not performed Reproductive/Urogenital: External genitalia normal in appearance Rectal: Not performed PROBLEM LIST: N/A DIAGNOSTICS: Skin: Tape prep ( Cocci + Rods+  )ASSESSMENT/DDX: History and physical examination findings consistent with allergic dermatitis/atopy DDx food allergy/adverse reaction, contact allergy, FADSecondary infection (bacteria) MEDICATION: Cephalexin 900mg BIDApoquel 24mg BID for 7 days then SIDPLAN:Continue Malsaeb washesCLIENT COMMUNICATION: Discussed the three pillars of allergic dermatitis: allergies, skin barrier and secondary infectionExpectations managed: ongoing management required Handouts given: Allergic Skin Disease  Estimate provided (Y/N or NA)    Vital Signs