C09976864 / invoice 10000

Reviewer

Species:CANINE

Breed:American Staffordshire Terrier

Age (years):2

Diagnosis or signs:GapOnly Claim Insurance Summary

Consult notes

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<div><em>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.<br></em></div>
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<div><strong>GapOnly claim Insurance Summary</strong></div>
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<p>First Clinic Signs: scratching<br><br><br>Summary:itchy skin, routine cytopoint inj<br><br><br>Diagnosis: allergies, cytopoint required<br><br><br>Treatment: cytopoint inj 40mg s/c batch #836645</p>
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Animal clinical history (3 most recent)

2025-12-01T00:00:00Z 11:23:00

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 Summary First Clinic Signs: scratchingSummary:itchy skin, routine cytopoint injDiagnosis: allergies, cytopoint requiredTreatment: cytopoint inj 30mg s/c batch #806984

2025-10-20T00:00:00Z 09:30:00

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 Summary First Clinic Signs: due for annual vaccination Summary: Honey a 1y3mo staffie FE presented today for her annual vaccination. EDDU normal. BAR. UTD with simparica trio, last time given 1 week ago. Has had diarrhoea for the last 3 days, no change in diet. Discussed about sending home with prokolin, but O has noticed improvement and deniedDiagnosis: healthy for vaccinationTreatment: C5- 1ml inj sc in between shoulder blades

2025-09-04T00:00:00Z 09:16:00

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 Clinic Signs: scratchingSummary:itchy skin, routine cytopoint injDiagnosis: allergies, cytopoint requiredTreatment: cytopoint inj 30mg s/c batch #806984

Previous claim history (4)

Date	Claim #	Diagnosis
2025-12-01	C09561530	HYPERSENSITIVITY (ALLERGIC) SKIN DISORDER
2025-10-20	C9374256	VACCINATIONS OR HEALTH CHECKS
2025-09-04	C9179088	HYPERSENSITIVITY (ALLERGIC) SKIN DISORDER
2025-05-16	C8720270	HYPERSENSITIVITY DISORDER (ALLERGY)

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

Line	tstarc	Amount	Date	Upstream diagnosis
10000	tstarc_skin_medication_-_cytopoint	155.00	2026-03-03	—
20000	tstarc_nursing_care	20.00	2026-03-03	—

UPM+

DG02319HYPERSENSITIVITY (ALLERGIC) SKIN DISORDERDSTP_skin_-_allergic_disorder

Variant (sleepy_king)

HYPERSENSITIVITY DISORDER (ALLERGY)

DSTP_skin_-_allergic_disorder

Conf: 1.000

Threshold: 0.38

Above: ✓

Correct?

Yes No