C10013225 / invoice 10000

Verified: YesClient: Presenting for ear infectionHistory: Lt ear pruritic. Checked couple months ago, no infection at that time. Hx of ear infections. No issues with skin.Exam:Mentation: BAR, nervous avoidant, loves treatsTemp: ?C Cardio: HR = PR = 100bpm, Resp: RR = 40, Eyes: wnlEars: Lt ear - marked debris/discharge present and moderate erythema, Rt ear wnlTeeth: Gde 0/4, Other oral exam: MM/CRT: pink/moist, CRT<2sAbdomen: wnlSkin & haircoat: wnlMusculoskeletal: wnlLymph Nodes: wnlNeurologic: wnlUrogenital: wnlRectal: Did not perform rectal examOther problems found:Assessment:Lt otitis externaDDx: Lt otitis externaPlan:Diagnostics: ear cytology- ++ yeast in Lt ear, Rt negTreatment: - otoflush SID for 5 days- dermotic 0.8ml Lt ear BID for 10 daysRecommendations & Client Comms: Ear flush allow minimum 30 minutes before applying dermotic. Use ear flush once daily for first 5 days of 10 day treatment period.Recheck: Yes, recheck in 10 days to assess if infection cleared or requires longer treatment28/02/2026 ncb/rph - No answer. No revisit booked. Reminders UTD

Verified: YESClient: husbandHISTORY Only an occasional small cough now and no more vomitting. Was very interested in getting breakfast this am but didn't feed in case needing xrays today. Mostly back to herself. No D or V.EXAMMentation: BAR, nervous avoidantHR = PR : 100bpmRR: 45Temp: 38.5CCardio: wnlResp: wnlEyes: wnlEars: wnlMouth/Dental Score: Gde 0/4 MM: mm pink moist CRT<2sAbdomen: wnlOther problems found: small cough on caudal tracheal pinchASSESSMENTcough DDx: KC, URT infection, aspiration, otherpyuria DDx: UTI, inflammationPLANDiagnostics: UA- ++ WBCs, trace bil and bloTreatment:continue amoxyclav 250mg 1.5 tablets BID until finishedAdditional Discussion and Client Comms:Gap payment discussed and arrangedRevisit: n/a19/1 Ongoing recheck no ncb today mc

Sheila and male O.Verified: YESHISTORY:Vomited last night - food, no blood present. Then has been coughing overnight, small amount white foam only. Normally very active, loves food but this morning did not want to eat and quieter in herself.Usual diet: Morning: chicken or chicken neck with Supercoat dry adult food. Evening: dry food with pet meat, rice and carrots. UTD F+W.Examination:QAR, both eyes + ears clear, nad, slns nad. mm p+m, crt<2s.HR 120 no hm reg rhythm. RR pant ausc/effort nad, no increased effort, no crackles.Abdo palp mild discomfort cranially but not painful.Skin turgor wnls.MSK nad.T 38.2.Bloods taken for chem16/cbc/sdma/lytes/PL.DDx: adv evidence of inflammation, has a hx of eating fb. Options to O:1) symptomatic tx only, recheck tomorrow am, xrays tomorrow afternoon if req.2) symptomatic tx + bloods, recheck tomorrow am, xrays tomorrow afternoon if req.3) transfer to GAE/GARS for radiographs + full work up (unfortunately do not have capacity today here).O chose option 2.Adv will call with results. Dispensed amoxyclav 250mg - 1.5 tabs BID just in case of any aspiration.Blood results: mild neutrophilia with bands suspected. Otherwise full bloods nad.Reported to Sheila. Adv evidence of inflammation, possible infection. Recc starting amoxyclav, tempt to eat with cooked chicken. Recheck tomorrow am , O to bring in urine sample. Any worsening at all/further vomiting today/overnight must ring GAE/GARS.