C09984649 / invoice 10000

Species:CANINE
Breed:Brittany Spaniel
Age (years):5
Diagnosis or signs:Ears
Consult notes
03/03/2026 HISTORY
- Previous treatments for ear infections and skin allergies
- Last Cytopoint injection was mid last year
- Last dental check was in August
- Last seen in November for vaccinations

EXAM
Ears: Left ear mucky and red, right ear has some redness but less muck. Cytology L ear ++++yeasts
Teeth: Mild tartar but sig gingivitis, halitosis noted
Skin: Pruritic, especially the feet; back feet more pink than front, abdomen looks good. Mild-mod inflammation caudal MC areas. Not scaly or thickened as per prev. Hair thinning but not total loss

DIAGNOSIS
- Otitis externa, predominantly in the left ear with Malassezia
- Dental disease with gingivitis and tartar buildup
- Dermatitis with pruritis

PLAN
1. Start treatment with Dermotic for ears, previously used with good results
2. Apply Dermotic BID for 10 days, extend to 14 days if redness or smell persists
3. Recheck ears in 2 weeks
4. Consider dental cleaning under Grade 1 pricing, focus on cleaning under the gum line
5. Apply dental gel daily to gums; reassess in 6 months for potential cleaning
6. Cytopoint injection to manage skin allergies and pruritis
7. Recheck general condition in 2 weeks

Animal clinical history (3 most recent)

2026-03-03T00:00:00Z 18:22:17
HISTORY
- Previous treatments for ear infections and skin allergies
- Last Cytopoint injection was mid last year
- Last dental check was in August
- Last seen in November for vaccinations

EXAM
Ears: Left ear mucky and red, right ear has some redness but less muck. Cytology L ear ++++yeasts
Teeth: Mild tartar but sig gingivitis, halitosis noted
Skin: Pruritic, especially the feet; back feet more pink than front, abdomen looks good. Mild-mod inflammation caudal MC areas. Not scaly or thickened as per prev. Hair thinning but not total loss

DIAGNOSIS
- Otitis externa, predominantly in the left ear with Malassezia
- Dental disease with gingivitis and tartar buildup
- Dermatitis with pruritis

PLAN
1. Start treatment with Dermotic for ears, previously used with good results
2. Apply Dermotic BID for 10 days, extend to 14 days if redness or smell persists
3. Recheck ears in 2 weeks
4. Consider dental cleaning under Grade 1 pricing, focus on cleaning under the gum line
5. Apply dental gel daily to gums; reassess in 6 months for potential cleaning
6. Cytopoint injection to manage skin allergies and pruritis
7. Recheck general condition in 2 weeks

Previous claim history (26)

DateClaim #Diagnosis
2025-03-26C8503538KERATITIS LEFT
2024-11-07C7917729VACCINATIONS OR HEALTH CHECKS
2024-11-07C7917729HEARTWORM CONTROL
2024-11-07C7917729ALLERGY
2024-05-23C7269192ARRHYTHMIA
2024-05-07C7202979TEETH CLEANING
2024-05-07C7202979BLOOD SCREEN
2024-04-30C7173378ALLERGY
2024-04-30C7173378EAR INFECTION
2023-11-16C6534285ALLERGY
2023-11-16C6534285HEARTWORM CONTROL
2023-11-16C6534285VACCINATIONS OR HEALTH CHECKS
2023-11-16C6534285FLEA/TICK/WORM CONTROL
2023-06-26C6031957CORNEAL ULCER
2023-06-26C6032659FOREIGN BODY - INTRA-OCULAR
2022-11-17C5311602ALLERGY
2022-11-03C5255109FLEA/TICK/WORM CONTROL
2022-11-03C5255109ALLERGY
2022-11-03C5255109HEARTWORM CONTROL
2022-11-03C5255109DENTAL ILLNESS TREATMENT
2022-08-11C5004346DESEXING
2022-04-23C4687918CORNEAL ULCER
2022-04-23C4687918DIETARY INDISCRETION - OTHER - PRESENTING COMPLAINT
2022-04-19C4669206CORNEAL ULCER
2022-03-21C4588520INTOXICATION (POISONING)/TOXIN EXPOSURE - PRESENTING COMPLAINT
2022-01-10C4383148DISCHARGE - OCULAR (EYE) - PRESENTING COMPLAINT

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

LinetstarcAmountDateUpstream diagnosis
10000tstarc_ear_medication_-_antibacterial_and_anti-fungal88.662026-03-03
20000tstarc_consultation119.002026-03-03
30000tstarc_diagnostic_test_-_cytology57.362026-03-03
40000tstarc_skin_medication_-_cytopoint219.322026-03-03

UPM+

  • DG02339HYPERSENSITIVITY DISORDER (ALLERGY)DSTP_skin_-_allergic_disorder
  • DG01185OTITIS EXTERNADSTP_otitis_externa

Variant (sleepy_king)

HYPERSENSITIVITY DISORDER (ALLERGY)
DSTP_skin_-_allergic_disorder
Conf: 0.460
Threshold: 0.38
Above:
Correct?