C09987755 / invoice 10000

04/03/2026 Reason: ears:

scratching, head shaking, vocal when rubbing at her ears:
EDUF all ok, 
No V or D
No current meds:

O has been cleaning the L ear with otoflush yesterday

Nervous more so when O is holding: O daughter holds very well

Mm pink, crt 2 s
PLN nad
Hr 108
RR 40
Nsf on abd palp: s and c

EARS:
R: nsf: ear is clean, no inflam changes on otoscopic exam, TPM intact
L: erythma external meatus, moderate inflam changes on otoscopic exam, marked amount of brown ceruminous, malodorous discharge, 
ear cleaned with 1ml otoflush, TPM intact, osurnia placed in the L ear

Tx:
Osurnia placed in the L ear
Pred 5mg: sid po 7d, 1/2 sid po 7d


Plan:
RV in 7 days for 2nd osurnia tx: has already been paid for

O re joining well ness plan:
10% of cytology pls