C09983309 / invoice 10000

Appointment Notes: Overdue reminders  ------- Sms reply: YesHistoryEDUF (Eating, Drinking, Urination, Defecation):Prophylaxis (Vaccination, Parasite Control):Physical ExaminationEars, Eyes, Nose, Oropharynx:Mucous Membranes (MM): Pink, moistCapillary Refill Time (CRT):Heart Rate (HR):Pulse Rate and Quality:Thoracic Auscultation:Abdominal Palpation:Temperature: 38.5Lymph Nodes:Musculoskeletal:Neurological Examination:Diagnostic Tests:Problem List:Assessment:Differential Diagnoses (DDx):Plan:    Vital Signs    

Reason: RecheckAppointment Notes: Overdue reminders  ------- Sms reply: YesHistory: hasn't been itching and scratching this last week. Ear cytology: much improved, both ears no bacteria and only occasional yeast.Plan: continue with ear cleaner as maintenance twice weekly, can stop with the dermotic drops.    Vital Signs    

Reason: RecheckAppointment Notes: Overdue reminders  ------- Sms reply: YesHistory: Did have an episode of two of breathing up overnight but intermittent, then went back to normal. Signs of ear pain resolving, not shaking her head or scratching as much. O says possibly R ear still bothering her. They have been uring the dermotic twiec daily dilligently. Skin tags bothering her but O's not keen to do anything about it as thinks too old for GA. On thyroid meds and cyclosporin. Examine: BAR chasing cat jumping aroundHR ~120 2/6 murmur no arrythmia Normal broncohvesicular soundsGIT large but NADMany many skin tags, did not map all Almost completley opaque L eye, neovascularisation progressing from ventromedial canthus Mild ceruminous discharge bilat, mild stenosis R ear. Moist bilat. Pinna wnl.Additional diagnostics:Ear cytology: L ear clear, R ear cocci resolved, yeast 2+ only. Improving dramatically with the 2x daily dermotic.  Treatment: Continue on the dermotic as yeast are resolving, just not quite fully resolved yet. Continue in R ear for 7 days then recheck swab one more time. If no resolution by then will need to think about different antifungal or neptra?    Vital Signs    Weight: 4.4;