C10020876 / invoice 10000

Reason: Recheck Of EarsAppointment Notes: KAHistory: Changed to roo diet last week L ear: dermotic bid last 9 days Rear: dex / flam Examine: R ear: clean and no discharge, walls pale L ear: inflammed narrowed canal with thick gooey nrown discharge to TM Laboratory: L ear: yeast 2+ , inflammatory cells ++ biofilm.Treatment: Clean L with saline Allow to dry for a few hours Neptra in LEFT ear Procedure for Neptra: 1. cytology should be done to confirm bacteria and or fungus (consult and cytology charge) 2. We will clean the ear prior to administration of the first dose** ears should be dry before applying meds ** use any ear cleaner ** make appointment for 2 weeks ** cytology should be done (charged but no repeat consult fee) ** a reminder is set after the first dose for 45 days recheck 3. please do not clean the ear with any product for 45 days after the first dose unless instructed by us to do so.    Vital Signs    Weight: 31.9;