C10023323 / invoice 10000

The intention of the following template is to clarify the minimum requirements for veterinary notes. This should not be used if it is a first claim as it will likely go on hold for more information required.GapOnly claim Insurance SummaryFirst Clinic Signs: About 3 days agoSummary: Developed a large rash on the chest and abdomen, has been itchy an sore.Diagnosis: Dermatitis possible allergy or sensitivityTreatment: Cephalexin 200mg 1 bid, apoquel 5.4mg 1 sid.

Reason: skin allergyDiagnosis: dermatitis, likely skin allergy- contact vs other eg food.History: Has always chewed at his paws, but not had severe reactions on the chest and abdomen before. About 3 days ago developed a large rash on the chest and abdomen. Other wise doing well EDDU normally. Did try some creams to help but did not help.Examine: Is aggressive O had him muzzled. Stressed.Mentation: BARBCS: 5/9MM: Pink CRT: <2EENM: Clean and clear with no discharge.Integument: skin on the chest, under the front legs and on the abdomen and prepuce had erythema, papules and some small sores. Smear showed no yeast but some cocci bacteria. The paws have chronic changes from chewing, alopecia and some thickening of the skin.Assessment: Likely has an allergy likely contact allergy, which has caused a massive allergic reaction leading to a dermatitis on the skin.Plan: Use a medicated wash and conditioner. Cephalexin 200mg 1 bid, and apoquel 5.4mg 1 sid, recommend using apoquel more frequently, or can trial antihistamines. r/c if not improved.