C10031659 / invoice 10000
Species:CANINE
Breed:Golden Doodle (Groodle)
Age (years):1
Diagnosis or signs:GHC - ear infection
Consult notes
<html><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><span style="font-weight: bold;"><strong>Clinical Notes checked:</strong> [Initial and Date]<br><br>History<br></span>
<p>- BIB {Tom and wife}<br><br>Diet - dry and wet food<br>Parasite control - NGS + TW UTD<br>Current meds nil<br><br>Groomer noticed brown discharge with ear. Otherwise no skin pruritis noticed at home. <br>Medical illnesses: <br>- history of HGE in Jan 26; GI symptoms have completely resolved <br><br><span style="font-weight: bold;">Exam</span>.<br>Demeanour: QAR, mild anxious, responds well to treats <br>Temp: not taken<br>BCS - 4.5/9<br>Eyes NSF<br>Ears Mod brown discharge with L ear, mild straw coloured discharge from R ear. <br>Oral exam: teeth healthy<br>Dental grade: 0/4<br>Cardiac ausc: HR= 120, no murmur, no arrhythmias<br>Respiratory: RR= pant, clear, eupnoeic<br>Abdo: NSF on abdo palpation<br>MSK: ambulatory without lameness in consult<br>Skin: mild pinkness with pinnae, periocular skin, interdigital skin of forelimbs, no weeping<br>L/N: NSF<br>Other findings:<br><br>Otoscopy - R ear canal healthy, TM intact, no excess discharge, L ear has mod brown discharge, unable to visualize distal horizontal ear canal or TM due to wax. Mild-mod hair in ext ear canals. No mass or FBs<br>Inhouse cytology - R ear NAD. L ear mod-marked malassezia (>20/hpf) and mild cocci (5/hpf)<br><br><br><span style="font-weight: bold;">Assessmen</span>t -<br>1. L OE.<br>- discussed keeping ears clean and dry following grooming, avoid swimming or water on the head<br>- monitor for signs of skin pruritis as ear infections may be early sign of skin allergy (e.g. food allergy, atopy). <br><br><strong>Treatments:<br>Aurocol 0.7ml into L ear BID for 10-14d. <br></strong><br>Revisit? 10-14d vet check and repeat cytology<br><br></p></html>
Animal clinical history (3 most recent)
2026-02-25T00:00:00Z 09:50:00
Clinical Notes checked: CDSHistory- BIB TomDiet - dry and wet (lamb based)Parasite control - nexgard spectra/TW UTDCurrent meds nilSee previous attached AES reports - was hospitalised for 3 nights with HGE 12/1, recovered with IVFT, maropitant, ondansetron and pro-kolin. It started on owner's wedding day! 1 week before it started they changed her diet without any transitioning.Here today for a recheck. Has been healthy since then. Has had 1-2 frothy bile vomits.Historically does get 1 bout of soft stools every now and again.Can be a scavanger.Exam.Demeanour: BARTemp: 38.9BCS - 5/9Eyes NSFEars NSFOral exam: mm pink moist crt 1sDental grade:0/4Cardiac ausc: HR=110bpmRespiratory: RR= clearAbdo: NSF on abdo palpation - soft and comfortable.MSK: NSF on joint palpationSkin: NSFL/N: NSFTests performed- clinical examAssessment - healthy todayPlan - Discussed HGE and possible causes (IBD/stress, infectious, dietary, idiopathic etc)Recommended keeping her diet consistent. Avoiding drinking from public water bowls. If she suffers from recurrent episodes over the next 1-2 years - may be indicative of IBD.Can always keep pro-kolin at home, to use at the first sign of any diarrhoea.Revisit?23/4 for AHC/vaccFollow up call?Reminders programmed?
2025-07-16T00:00:00Z 10:21:00
HistoryBIB {fowner} KathleePresenting for a POC 2 weeks following spey (2/7/25)Last recheck noticed some irritation from the glue from primapore.Any concerns: NoneCurrent medication: None - query sensitivity to meloxicam (diarrhoea when on it, resolved once stopped)O assessment of pain: NoneExaminationDemeanour: BAR, friendlyOral exam: MM Pink, moist CRT<2sChest ausc: WNL, HR 132, no murmurs, strong pulsesSurgical site: Healed well, some areas of scabbing, no effusion or pain noted. Intradermal sutures intact, no evidence of unravelling.Next point of follow up: None2025-07-05T00:00:00Z 10:26:00
EDDU normalone off loose stools yesterday (no blood or mucus), this has normalized todayappetite goodoccasional scratching attempts at surgical site, otherwise back to normalPe:QARHR 140, no murmurMM pink, crt 1sRR 16, clearT 38.7Superficial excoriation to ventral skin of sternum, scratching this area with hindpawPatch removed, moderate rash at areas of primapore gluesmall bruise mid surgical line, otherwise skin line is apposed and healthyAx:healing wellrash to glue and signs of self trauma to ventral sternum regionPlan;Neocort cream BID 3-5d prnE collar, +/- onsie to prevent self traumaContinued exercise restrictionrevisit at 2 weeks recheck
Previous claim history
| Date | Claim # | Diagnosis |
|---|---|---|
| No prior claims. | ||
Line items(lines with upstream diagnosis are skipped by the model)
| Line | tstarc | Amount | Date | Upstream diagnosis |
|---|---|---|---|---|
| 10000 | tstarc_consultation | 136.00 | 2026-03-14 | — |
| 20000 | tstarc_diagnostic_test_-_cytology | 69.00 | 2026-03-14 | — |
| 30000 | tstarc_ear_medication_-_antibacterial_and_anti-fungal | 66.26 | 2026-03-14 | — |
UPM+
- DG01185OTITIS EXTERNADSTP_otitis_externa
Variant (sleepy_king)
OTITIS EXTERNA
DSTP_otitis_externa
Conf: 0.870
Threshold: 0.07
Above: ✓
Correct?