C09979192 / invoice 10000

Species:CANINE
Breed:American Staffordshire Terrier
Age (years):7
Diagnosis or signs:Ears
Consult notes
R ear

HISTORY
Presenting for: Mazey presented for ear issues and skin problems
Historical Conditions: Cytopoint for allergic skin condition monthly. 
Skin: History of chronic allergic skin condition, currently on Cytopoint injections which work reasonably well but may not be controlling current flare adequately
ears - right ear itchy, shaking head
well otherwise
Current Meds: Cytopoint monthly

EXAM
mm pink, crt<1s, HR 92 bpm lung sound snad
Ears: Right ear - moderate redness in canal with moderate dark brown discharge
. Left ear - mild erythema present
Integumentary: perivulvar dermatitis, dermatitis caudal abdomen
left mammary chain from mid abdomen caudal diffusely swollen - no discrete masses feels like oedema. 

ASSESSMENT
R ear OE likely malassezia
L mild OE
periulvar dermatitis - Secondary to allergic skin condition and licking behaviour
mammary swelling - trauma, inflammation?

PLAN
New Meds/Tx:

R ear - 1.5 ml PMP daily 14 days
Otoflush -  ear wash for both ear daily for 5 days, then twice weekly
Apoquel 16mg tablets bid 7 days
cytopoint - when due

Client Comms:
- Recheck appointment scheduled in 10-14 days to assess treatment response and ear condition, cytopoint, recheck mammary chain
- Monitor for any worsening of symptoms during treatment period

Animal clinical history (3 most recent)

2026-03-03T00:00:00Z 11:42:00
R ear

HISTORY
Presenting for: Mazey presented for ear issues and skin problems
Historical Conditions: Cytopoint for allergic skin condition monthly. 
Skin: History of chronic allergic skin condition, currently on Cytopoint injections which work reasonably well but may not be controlling current flare adequately
ears - right ear itchy, shaking head
well otherwise
Current Meds: Cytopoint monthly

EXAM
mm pink, crt<1s, HR 92 bpm lung sound snad
Ears: Right ear - moderate redness in canal with moderate dark brown discharge
. Left ear - mild erythema present
Integumentary: perivulvar dermatitis, dermatitis caudal abdomen
left mammary chain from mid abdomen caudal diffusely swollen - no discrete masses feels like oedema. 

ASSESSMENT
R ear OE likely malassezia
L mild OE
periulvar dermatitis - Secondary to allergic skin condition and licking behaviour
mammary swelling - trauma, inflammation?

PLAN
New Meds/Tx:

R ear - 1.5 ml PMP daily 14 days
Otoflush -  ear wash for both ear daily for 5 days, then twice weekly
Apoquel 16mg tablets bid 7 days
cytopoint - when due

Client Comms:
- Recheck appointment scheduled in 10-14 days to assess treatment response and ear condition, cytopoint, recheck mammary chain
- Monitor for any worsening of symptoms during treatment period

Previous claim history (17)

DateClaim #Diagnosis
2026-02-17C09919840CONSTIPATION
2026-01-17C09774146HYPERSENSITIVITY (ALLERGIC) SKIN DISORDER
2025-12-20C09655047HYPERSENSITIVITY DISORDER (ALLERGY)
2023-05-05C5904046ATOPY
2023-03-01C5642852CYST
2023-03-01C5642852ALLERGY
2022-11-10C5280215MISCELLANEOUS CONDITIONS
2022-10-06C5173867ATOPY
2022-07-29C4967545ATOPY
2022-02-09C4497105DESEXING
2022-02-09C4497105VACCINATIONS OR HEALTH CHECKS
2022-02-09C4497105ATOPY
2021-02-04C3571311ATOPY
2021-02-04C3571311VACCINATIONS OR HEALTH CHECKS
2021-01-29C3514850VOMITION & DIARRHOEA
2021-01-29C3514857VOMITION & DIARRHOEA
2020-11-05C3511491PYODERMA

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

LinetstarcAmountDateUpstream diagnosis
10000tstarc_consultation123.002026-03-03
20000tstarc_ear_medication_-_antibacterial67.402026-03-03
30000tstarc_ear_cleaner29.852026-03-03
40000tstarc_skin_medication_-_apoquel108.302026-03-03
50000tstarc_unrelated_treatment28.752026-03-03
upstreamDSTP_general_exclusion

UPM+

  • DG02339HYPERSENSITIVITY DISORDER (ALLERGY)DSTP_skin_-_allergic_disorder

Variant (sleepy_king)

HYPERSENSITIVITY DISORDER (ALLERGY)
DSTP_skin_-_allergic_disorder
Conf: 0.630
Threshold: 0.38
Above:
Correct?