C10010696 / invoice 20000

Examine:  Round lesion in the left upper lip linguinal side is a little less raised today but there is still active surface ulceration.Differential Diagnosis:  Hyperplasia from rubbing with tooth, neoplasiaPlan:  TGH with more a/b but consider biopsy if not resolving to be sure it is not neoplastic.    Vital Signs    

Reason: Cut On Mouth- Actively Bleeding History: blood from mouth after chewing treat this morningExamine: T  39.0   HR  132   RR panting    mm pink, rt1sMouth/Teeth: C2G1Has 1cm round ulceration with mild tissue thickening on oral mucosa left upper muzzle behind 204. Lines up with tooth 306 but is circular so concerns for neoplasia.Small dull lesion in corresponding area on right side.Impression smear nsf- neuts, various sized rods, mucosal epithelium.Cardiovascular: murmurRespiratory: nadNodes: nadDifferential Diagnosis: circular oral mucosa ulcer- neoplasia ddx trauma, infectionPlan: a'b, meloxicam (has at home) & recheck next week to assess progress.Photos on file & AC has felt/seen too.Discussed may require incisional biopsy for dx & treatment plan if suspicious of neoplasia.    Vital Signs    Weight: 7.8;