Mar 21, 2011 DOB (310) REMINDERS. Nov 19, 2014 Sep 04, 2015 Nov 03, 2015 Nov 05, 2016 Nov 05, 2016 PATIENT ALERTS (MANUAL)

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1 Media City Animal Hospital Medical Chart PATIENT SPECIES AGE Daisy Canine 4 years OWNER Helen Lee SEX COLOR ID BREED DOB Female Unaltered Bulldog Mar 2, 20 ADDR 250 S. San Fernando Rd, Apt 24 MARK Tan Burbank, CA 9502 PHONE (30) helenmelonlee@gmail.co NOTES REASON FOR VISIT IN OUT PROBLEMS REMINDERS Nov 9, 203 Atopy Nov 9, 204 Sep 04, 205 Nov 03, 205 Nov 05, 206 Nov 05, 206 ** Fecal Parasite Screen with Giardia E Office Visit Kennel Cough / Bordetella- year DHP 3 Year Vaccine Rabies (3 year) WEIGHT HISTORY Nov 03, 204 Oct 20, 204 Oct 06, 204 Sep 22, lb 9 oz 40 lb 7 oz 4 lb 6 oz 42 lb 0 oz PATIENT ALERTS (MANUAL) No KETOCONAZOLE per Owner. Concerned about liver damage. MEDICAL HISTORY ITEM DESCRIPTION QTY ALL HISTORY /3/204 Isabel Chan, DVM MCV99 Kennel Cough / Bordetella- year /3/204 /3/204 Posatex Posatex Otic box Rx Num: Refills: 0.00 Expires: /3/205 Apply 8 drops to the right ear once a day after cleaining 234 Ear Cytology /3/204 /3/ Office Visit, Follow-Up recheck ears and update vaccines right: recheck ears and update vaccines right ear less inflamed ext canal taking pred EOD and using oint ment due for Bord today Vitals: 4:8pm /3/4 Wt: 40 lb. 9 oz. T: 00 F. By: YS Ears: Right ear ext canal more open, but internally still swollen and can't see eardrum, left ear normal eardrum w/ small amt oint AD otitis externa continuing, but improved on pred oral, r/o resistant bacteria vs FB vs other. Ear cytology: 4+ cocci AD rec continue pred EOD rec c/s of ear vs going to ADC for consult Rx Posatex sig 8 drops AD SID after cleaning for 7d o elects to see dermatologist for further consultation Media City Animal Hospital Page of 5 4/5/205 3:24 p.m.

2 Vaccines: Bord oral yr 0/20/204 0/20/204 0/20/204 Triotic 5 TriOtic(Otomax) Oint. 5 mg.(generic) tube Use this medication as directed. If vomiting, lethargy, or decreased appetite occur, discontinue use and contact the Doctor's office. Rarely, it can cause ear discomfort, an apparent decrease or loss of hearing, or a head tilt. If any of Rx Num: 8396 Refills: 0.00 Expires: 7//206 Apply to the right ear twice daily for 7 days, then once daily fro 7 days. Pred 0 Prednisone 0mg 20 tab Prednisone may cause increased thirst, increased urination, increased appetite, and panting. Always give with food, and give as directed. Never combine prednisone with non-steroidal anti-inflammatory drugs, such as aspirin, rimadyl (carprofen), or deramaxx (deracoxib). Rx Num: 8395 Refills: 0.00 Expires: 4/28/206 Give one tablet orally twice daily for 3 days, then once daily for 3 days, then every other day. 234 Ear Cytology 0/20/204 0/20/ Office Visit, Follow-Up recheck right ear still swollen shut an: recheck right ear still swollen shut and bothering her yellowish discharge Vitals: 4:9pm 0/20/4 Wt: 40 lb. 7 oz. T: 00.8 F. By: CS Ears: right ear swollen canal and cannot scope, too painful and swollen to see much, moist yellow debris, Left ear has slight yellow waxy debris, but scopes normal Otitis externa AD continuing Ear cytology: AD: Rx Pred 0mg #20 sig BID x 3d, then SID x 3d, then EOD Rx Tri-otic 5ml BID AD x 7d then SID x7d to go back to daily flushing AU with oticlens, or epi-otic, o has recheck 2 wks. Vaccines: 0/6/204 0/6/204 Isabel Chan, DVM 707 Convenia Injection per ml.8 ml Isabel Chan, DVM Zymox HC Zymox W/Hydrocortisone Bot 0/6/204 0/6/204 0/6/204 Use this medication as directed. If vomiting, lethargy, or decreased appetite occur, discontinue use and contact the Doctor's office. Rarely, it could can ear discomfort, an apparent decrease or loss of hearing, or a head tilt. If any of Rx Num: Refills: 0.00 Expires: 3//206 Apply once daily to the right ear. Isabel Chan, DVM 234 Ear Cytology Isabel Chan, DVM 03 Office Visit, Follow-Up recheck ear seemed fine while on the BN: recheck ear seemed fine while on the BNT for the past 2 weeks, but started scratching again past couple days. Media City Animal Hospital Page 2 of 5 4/5/205 3:24 p.m.

3 Vitals: 4:5pm 0/6/4 Wt: 4 lb. 6 oz. T: 00.5 F. By: CS Ears: right ear canal swollen shut and painful when swabbed, minimal inflammation. Otitis externa AD bacterial continuing Ear cytology AD: 2+ paired cocci.8ml Convenia SQ (4:4PM 0/6/4 Cunningham, Breanna) Rx Zymox w/ HC AD SID x 2wks Recheck 2 wks. may need oral pred if not improving, to talk to dermatologist if nec. 9/22/204 9/22/204 9/22/204 9/22/204 BNT BNT Ear Treatment 234 Ear Cytology 03 Office Visit, Follow-Up recheck still scratching at night. rig: recheck still scratching at night. right ear still bothering her using oticlens EOD and triotic SID AD only Vitals: 4:27pm 9/22/4 Wt: 42 lb. oz. T: 00.4 F. By: BC Ears: right ear canal still narrowed and painful when scoped, w/ yellow/white discharge, left ear mild inflam, eardrum ok Otitis externa AD not resolving Ear cytology: AD only: + cocci, occ yeast Rx BNT /2 cc AD applied recheck 2 wks. Vaccines: 9/4/204 9/4/204 9/4/ Ear Cytology 0 Office Visit Exam Skin is good, not seeing dermatolo: Exam Skin is good, not seeing dermatologist anymore right ear is flaring up again Changed scoop to /2 cup and gets BID, has lost 3 lbs! Media City Animal Hospital Page 3 of 5 4/5/205 3:24 p.m.

4 Vitals: 5:02pm 9/4/4 Wt: 42 lb. oz. T: 0.4 F. By: KR General Appearance: BAR, BCS 5 - Ideal Eyes: Corneas clear, pupils normal size, symmetrical; sclera white, no ocular discharge Ears: right ear narrowed canal, yellow discharge, mod inflam, cannot scope, painful, left ear normal to drum Integument: Normal amount of shedding; skin looks normal; hair coat in good condition Oral Cavity: Teeth are free from excessive tartar; gums are pink and moist; no gingivitis present Lymphatics: Lymph nodes all normal size Cardiovascular: Regular rhythm; no murmur detected; strong femoral pulses; CRT < 2 sec Musculoskeletal: Ambulates normally Gastrointestinal: Normal eliminations; palpates normally Urogenital: Owner reports normal eliminations; external genitalia appears normal; bladder palpates normally Respiratory: Lungs ascultate clear; trachea clear Neurologic: No apparent abnormalities Pain : Pain Evaluation Performed Otitis externa AD bacterial Ear cytology: AD: 4+cocci Rx O has tri-otic 5ml and oticlens from dermatologist ok to use these tri-otic BID x7d, then sid x7d ok to refill if runs out before 2 wks To watch body weight and feed more if continuing to lose more weight. recheck ear 2 wk. Vaccines: 4/2/204 Triotic 5 TriOtic(Otomax) Oint. 5 mg.(generic) tube 4/2/204 4/2/204 4/2/204 Use this medication as directed. If vomiting, lethargy, or decreased appetite occur, discontinue use and contact the Doctor's office. Rarely, it can cause ear discomfort, an apparent decrease or loss of hearing, or a head tilt. If any of Rx Num: Refills: 0.00 Expires: 8/3/204 Apply to the right ear twice daily for 7 days then once daily for 7 days 234 Ear Cytology 0 Office Visit check ears Lotus low calorie food dry o: Reason for Visit: Exam check ears Lotus low calorie food dry only Gained 5 pounds since last visit Skin is improved since getting hyposensitization inj's at dermatologist no more pustules on the chin right ear only is infected Vitals: 2:9pm 4/2/4 Wt: 45 lb. T: 99.8 F. HR: 20 RR: 40 By: EQ General Appearance: BAR, BCS 7 - Overweight Eyes: Corneas clear, pupils normal size, symmetrical; sclera white, no ocular discharge Ears: right ear inner pinna crusted and mod inflam, scopes mild yellow discharge, eardrum intact, mild inflam. Left ear normal to drum Integument: Normal amount of shedding; skin looks normal; hair coat in good condition Oral Cavity: Teeth are free from excessive tartar; gums are pink and moist; no gingivitis present Lymphatics: Lymph nodes all normal size Media City Animal Hospital Page 4 of 5 4/5/205 3:24 p.m.

5 Cardiovascular: Regular rhythm; no murmur detected; strong femoral pulses; CRT < 2 sec Musculoskeletal: Ambulates normally Gastrointestinal: Normal eliminations; palpates normally Urogenital: Owner reports normal eliminations; external genitalia appears normal; bladder palpates normally Respiratory: Lungs ascultate clear; trachea clear Neurologic: No apparent abnormalities Pain : non painful overweight otitis externa right only Ear cytology: 4+ yeast, occ cocci Rx Tri-otic 5ml sig BID right ear x 7d, then SID x 7d recheck ear 2 wks Rec wt loss, to look for a lower calorie food (eg Fat Dog 250cal/cup) or feed less or add water /4/204 /20/203 Reception Please call owner /4/4 6:42pm by JL : LMOC Fecal Float / Giardia Elisa /20/3 2:3pm by IC : please call owner with negatvie fecal results. /20/3 3:09pm by MCF : spoke with o told them fecal is neg- /9/203 /9/203 /5/203 /5/203 Isabel Chan, DVM FFG Fecal Parasite Screen with Giardia Elisa IC Lab Result ID: Status: Pending Laboratory: Profile: Antech - Zoasis West Ova & Parasite with Giardia Test Results Range Giardia and Ova w/ C Reqested By: Reqested On: /20/203 04:6 AM Accession Result ID: Accession Status: F Clinic Accession ID: Chart ID: Lab Accession ID: IRBE Order Received: /9/203 Latest Results Received: /20/203 02:26 AM Pet Name: DAISY Pet Age: 2Y Pet Sex: F Pet Species: Canine Pet Breed: Pet Owner: LEE HELEN Pet Doctor: ISABEL CHAN, DVM Ova & Parasite Giardia (ELISA) None Seen Negative MCV99 Kennel Cough / Bordetella- year MRB3 Rabies (3 year) Your pet has just received a vaccination. And while vaccination reactions are rare, it is important to monitor your pet after the vaccine is administered for any signs of adverse reaction, which can range from mild to severe. Mild: mild reactions include fever, sluggishness, and loss of appetite. These symptoms usually resolve without treatment. Moderate: some pets may develop a reaction of the skin marked by hives or wheals and rapid swelling and redness of the lips, around the eyes, and in the neck region. It rarely progresses to anaphylaxis, which is considered life-threatening. If your pet experiences any of these symptoms, you should return to a veterinarian for medical treatment. Severe: The most severe reaction is anaphylaxis. Symptoms usually include sudden onset of vomiting, diarrhea, staggering, and breathing difficulty. It is very important that you bring your pet into the veterinarian or the emergency clinic as soon as these symptoms are noted in your pet. Vaccine Num: 893C Type: Killed Mfg: Merial Route: SQ Expires: 2/9/204 Media City Animal Hospital Page 5 of 5 4/5/205 3:24 p.m.

6 /5/203 MCV4 DHPP 3 Year /5/203 Metronid 250 Metronidazole 250mg 5 tab This medication has a bitter taste. Occasionally pets may salivate after taking it. The salivation is a reaction to the bitter taste. Very rarely, metronidazole can cause dizziness, a head tilt, loss of balance, or a seizure. If any of these occur, discontinue use and contact your doctor. Rx Num: Refills: 0.00 Expires: 6/30/204 Give one and a half tablet twice a day for 5 days /5/203 recheck liver values and update vaccines: Reason for Visit: Exam recheck liver values and update vaccines Was seen by Dr. Angus and started antigen injections did fine on 0.5ml EOD, but when gave.0ml the second time she collapsed and had vom/diar and had to be hospitalized at ASG 0/7/3 The liver values were elevated: ALT and AST in 400's She went on Pred and benadryl and has re started the injections at 0.5ml q 4d with 50mg Benadryl hr before the injection. Eating Z/D dry only, has had loose stool since the episode Now due for all 3 dog vax also Found vax history from Cahuenga Pet Hosp DHLPP was given 7/2, Rabies 7/2, Bord 6/2 Vitals: 6:8pm /5/3 Wt: 40 lb. 3.2 oz. T: 0 F. HR: 20 RR: 40 By: JL General Appearance: BAR, BCS 5 - Ideal Eyes: Corneas clear, pupils normal size, symmetrical; sclera white, no ocular discharge Ears: No exudate observed; no redness present Integument: one pustule on chin, may be a scar, and right front foot 3rd digit dorsally has a 3mm area of alopecia. Rest of skin looks great! Oral Cavity: Teeth are free from excessive tartar; gums are pink and moist; no gingivitis present Lymphatics: Lymph nodes all normal size Cardiovascular: Regular rhythm; no murmur detected; strong femoral pulses; CRT < 2 sec Musculoskeletal: Ambulates normally Gastrointestinal: Normal eliminations; palpates normally Urogenital: Owner reports normal eliminations; external genitalia appears normal; bladder palpates normally Respiratory: Lungs ascultate clear; trachea clear Neurologic: No apparent abnormalities Pain : non painful Atopy on antigen injections Anaphylaxis after antigen inj 0/7/3 due for vax DHPP 3yr Rabies 3yr Bord IN Vetscan first: Normal liver values! Rx Metronidazole 250mg #5 sig and /2 tab po BID for 5 days. if not improving, to send in FFG Invoiced Items: Metronidazole 250mg -- Qty: 5 -- This medication has a bitter taste. Occasionally pets may salivate after taking it. The salivation is a reaction to the bitter taste. Very rarely, metronidazole can cause dizziness, a head tilt, loss Media City Animal Hospital Page 6 of 5 4/5/205 3:24 p.m.

7 of balance, or a seizure. If any of these occur, discontinue use and contact your doctor. --Give one and a half tablet twice a day for 5 days DHPP 3 Year -- Qty: Rabies (3 year) -- Qty: --Your pet has just received a vaccination. And while vaccination reactions are rare, it is important to monitor your pet after the vaccine is administered for any signs of adverse reaction, which can range from mild to severe. Mild: mild reactions include fever, sluggishness, and loss of appetite. These symptoms usually resolve without treatment. Moderate: some pets may develop a reaction of the skin marked by hives or wheals and rapid swelling and redness of the lips, around the eyes, and in the neck region. It rarely progresses to anaphylaxis, which is considered life-threatening. If your pet experiences any of these symptoms, you should return to a veterinarian for medical treatment. Severe: The most severe reaction is anaphylaxis. Symptoms usually include sudden onset of vomiting, diarrhea, staggering, and breathing difficulty. It is very important that you bring your pet into the veterinarian or the emergency clinic as soon as these symptoms are noted in your pet. Kennel Cough / Bordetella- year -- Qty: /5/203 /5/203 /5/203 0 Office Visit 992 Vetscan Chemistries JL Lab Result ID: 0654 Status: Posted Laboratory: Profile: VetScan VS2 DOG Test Results Range ALB QC OK HEM 2+ LIP 0 ICT 0 ALP ALT AMY TBIL BUN Ca PHOS CRE GLU Sodium K+ TP GLOB NA+ 3.7 g/dl U/L U/L U/L mg/dl mg/dl mg/dl mg/dl mg/dl mg/dl mmol/l g/dl g/dl mmol/l /5/203 recheck liver values and update vaccines: Reason for Visit: Exam recheck liver values and update vaccines Was seen by Dr. Angus who started antigen injections Did fine on the EOD 0.5ml, but when started w/.0ml, she collapsed after the second one went to ASG for Pred/benadryl and IVF support 0/7/3. Labwork 0/9 showed ALT and AST elevated=400 Restarted the injections at 0.5ml q 0 days and to give 50mg Benadryl hr before inj. doing fine with that now. Has been off the pred for past 2 weeks. Skin has been good Eating Z/D dry only, still having some soft stools. Due for all 3 vax Vitals: 5:30pm /5/3 Wt: 40 lb. oz. By: KMC General Appearance: BAR, BCS 5 - Ideal Eyes: Corneas clear, pupils normal size, symmetrical; sclera white, no ocular discharge Media City Animal Hospital Page 7 of 5 4/5/205 3:24 p.m.

8 Ears: No exudate observed; no redness present Integument: One pustule on chin, could be a scar, right front foot 3rd digit has an alopecic area 3mm dorsally, neither one looks inflamed. Rest of skin very good Oral Cavity: Teeth are free from excessive tartar; gums are pink and moist; no gingivitis present Lymphatics: Lymph nodes all normal size Cardiovascular: Regular rhythm; no murmur detected; strong femoral pulses; CRT < 2 sec Musculoskeletal: Ambulates normally Gastrointestinal: Normal eliminations; palpates normally Urogenital: Owner reports normal eliminations; external genitalia appears normal; bladder palpates normally Respiratory: Lungs ascultate clear; trachea clear Neurologic: No apparent abnormalities Pain : Non painful Atopy on antigen injections liver values high after Anaphylactic episode 0/7/3 Due for VAx Diagnosis: Atopy (Added to Problem List) Vetscan in house: Invoiced Items: Office Visit -- Qty: Vetscan Chemistries -- Qty: 0/24/203 Isabel Chan, DVM z/d ultra 25# Z/D Ultra Canine 25 lb. Bag 0/8/203 9/7/203 Leigh Trout, DVM Leigh Trout, DVM asg update 0/8/3 :39am by LT : hospitalized at ASG on ER for anaphylactic reaction to allergy injection. ADC 9/7/3 5:30pm by LT : skin doing great, managed on variety of topical tx. 8/6/203 Isabel Chan, DVM z/d ultra 25# Z/D Ultra Canine 25 lb. Bag 8//203 7/29/203 Leigh Trout, DVM Leigh Trout, DVM how is daisy's sleepiness 8//3 :3am by LT : LMOM- how is Daisy doing? 8//3 :6am by LT : TTO- Much better now that split apart baytril and ketoconazole. normal self. side effects of medication? 7/29/3 7:2pm by LT : TTO- skin doing great! but last couple days has seemed sleepy. not overtly lethargic, but just noticeably more tired. also PUPD, panting. advised PUPD, Panting is expected w/ pred; sleepiness would not expect w/ any of the meds (not giving benadryl). Rec break up admin of ketoconazole and baytril in case upsetting stomach (had been giving both together in morning with breakfast), rec faster taper of pred- tomorrow go to SID x 3 d then EOD x 3 d- will call and touch base when I'm back in officee of Thurs, but contact other DVM sooner if mild sleepiness progresses to lethargy/not feeling well. 7/26/203 7/26/203 7/26/203 7/26/203 Leigh Trout, DVM Ketocon 200 Ketoconazole 200 mg 7 tab Ketoconazole is an antifungal drug. Very rarely, it can cause liver problems. Blood work should be done before starting it. Your doctor may recommend that blood work be done during treatment also. If your pet develops a poor appetite, vomiting, diarrhea, or lethargy on this medication, discontinue use and call your doctor. Rx Num: Refills: 0.00 Expires: 0//203 Give /2 tablet orally once a day for 2 weeks Leigh Trout, DVM Enroflox 36 Baytril 36 mg.tab./chew. 2 tab. Rx Num: Refills: 0.00 Expires: 7/3/205 give /2 tablets orally once a day for 2 weeks Leigh Trout, DVM Pred 0 Prednisone 0mg 20 tab Prednisone may cause increased thirst, increased urination, increased appetite, and panting. Always give with food, and give as directed. Never combine prednisone with non-steroidal anti-inflammatory drugs, such as aspirin, rimadyl (carprofen), or deramaxx (deracoxib). Rx Num: Refills: 0.00 Expires: 4/28/206 Give tablet orally twice a day for 5 days, then once a day for 5 days, then every other day Leigh Trout, DVM Skin Cytology 7/26/203 7/26/203 Leigh Trout, DVM 234 Ear Cytology Leigh Trout, DVM 0 Office Visit Media City Animal Hospital Page 8 of 5 4/5/205 3:24 p.m.

9 7/26/203 Leigh Trout, DVM Exam chronic skin allergies- currently: Reason for Visit: Exam Exam chronic skin allergies- currently on z/d x few months- no overall improvement. skin flares up q few wks year round. UTD monthly flea/tick, wipe skin folds regularly w/ duoxo wipes. no v/d/c/s/pupd. good appetite, eliminations wnl. Vitals: 2:0pm 7/26/3 Wt: 4 lb. T: 0. F. HR: 0 RR: 24 CRT: <2.0 By: EQ General Appearance: Bright, alert and responsive; good body condition Eyes: Corneas clear, pupils normal size, symmetrical; sclera white, no ocular discharge Ears: AD>AS concave pinnal erythema and yellow exudate w/in vertical and horizontal canals; AD canals minimal exudate Integument: facial skin folds raw, superficial ulceration; ventral skin pyoderma; interdigital erythema and yellowish exudate Oral Cavity: Teeth are free from excessive tartar; gums are pink and moist; no gingivitis present Lymphatics: Lymph nodes all normal size Cardiovascular: Regular rhythm; no murmur detected; strong femoral pulses; CRT < 2 sec Musculoskeletal: Ambulates normally Gastrointestinal: Normal eliminations; palpates normally Urogenital: Owner reports normal eliminations; external genitalia appears normal; bladder palpates normally Respiratory: Lungs ascultate clear; trachea clear Neurologic: No apparent abnormalities Pain : Pain Evaluation Performed. skin fold dermatitis 2. r/o allergic dermatitis- r/o CAFR v AD ear cytology: AU occ- + cocci skin cytology interdigital, facial fold, tail base: rods 4+, yeast 4+, cocci 4+ RX epi-otic- flush AU SID x 2 wks- client has at home RX enrofloxacin 36 mg- give /2 tab PO SID x 2 wks # 2 RX ketoconazole 200 mg- give /2 tab PO SID x 2 wks #7 RX prednisone 0 mg- tab PO BID x 5 d then SID x 5 d then EOD x 5 d #20 clients to try benadryl 25 mg- /2 tab PO SID rec foot baths when come in from outside rec consult w/ dermatologist for allergy testing Invoiced Items: Office Visit -- Qty: Ear Cytology -- Qty: Skin Cytology -- Qty: Prednisone 0mg -- Qty: 20 --Prednisone may cause increased thirst, increased urination, increased appetite, and panting. Always give with food, and give as directed. Never combine prednisone with non-steroidal anti-inflammatory drugs, such as aspirin, rimadyl (carprofen), or deramaxx (deracoxib). -- Baytril 36 mg.tab./chew. -- Qty: 2 -- Epi Otic Advanced 8oz -- Qty: Ketoconazole 200 mg -- Qty: 7 --Ketoconazole is an antifungal drug. Very rarely, it can cause liver problems. Blood work should be done before starting it. Your doctor may recommend that blood work be done during Media City Animal Hospital Page 9 of 5 4/5/205 3:24 p.m.

10 treatment also. If your pet develops a poor appetite, vomiting, diarrhea, or lethargy on this medication, discontinue use and call your doctor. --Give /2 tablet orally once a day for 2 weeks 6/0/203 4/29/203 4/29/203 Hospital z/d ultra 25# Z/D Ultra Canine 25 lb. Bag Zymox Otic Zymox Otic Solution-.25oz. Bot Use this medication as directed. If vomiting, lethargy, or decreased appetite occur, discontinue use and contact the Doctor's office. Rarely, it could can ear discomfort, an apparent decrease or loss of hearing, or a head tilt. If any of Rx Num: Refills: 0.00 Expires: 2/3/204 Shake well, apply to left ear filling canal and massage once a day for 2 weeks. 707 Convenia Injection per ml.9 ml 4/29/203 4/29/203 4/29/ Ear Cytology 03 Office Visit, Follow-Up recheck ear and chin Left ear less itch: Reason for Visit: Exam recheck ear and chin Left ear less itchy now and chin less red also taking Pred 0 EOD Vitals: 4:36pm 4/29/3 Wt: 40 lb. oz. T: 0.2 F. By: JL Ears: Left ear still mild inflam and yellow waxy debris can't see eardrum completely, right ear WNL Integument: chin pustules are all gone except a few on each side of lower lips Otitis externa Left, improving chin acne improving Ear cytology: 2+ cocci paired, no yeast or rods seen to switch to Rx: zymox w/hc SID into the left ear for 2 weeks. Convenia 2ml SQ Recheck in 2 weeks. If still cocci in ear, get C/S Invoiced Items: Office Visit, Follow-Up -- Qty: Ear Cytology -- Qty: Convenia Injection per ml -- Qty:.9 Zymox Otic Solution-.25oz. -- Qty: --Use this medication as directed. If vomiting, lethargy, or decreased appetite occur, discontinue use and contact the Doctor's office. Rarely, it could can ear discomfort, an apparent decrease or loss of hearing, or a head tilt. If any of --Shake well, apply to left ear filling canal and massage once a day for 2 weeks. 4/9/203 4/9/203 4/9/203 Chlorhex pads Douxo Chlorhexadine 3% Pads 30ct. ea Rx Num: Refills: 0.00 Expires: 4/9/204 Wipe once a day on chin z/d ultra 8#k z/d Ultra Canine 8 lb Bag Pred 0 Prednisone 0mg 4 tab Media City Animal Hospital Page 0 of 5 4/5/205 3:24 p.m.

11 4/9/203 Prednisone may cause increased thirst, increased urination, increased appetite, and panting. Always give with food, and give as directed. Never combine prednisone with non-steroidal anti-inflammatory drugs, such as aspirin, rimadyl (carprofen), or deramaxx (deracoxib). Rx Num: Refills: 0.00 Expires: 4/28/206 Give /2 tab daily for 3 days, then /2 tablet every other day for itching. 707 Convenia Injection per ml.9 ml 4/9/203 4/9/203 4/9/203 4/9/203 BNT BNT Ear Treatment 234 Ear Cytology 0 Office Visit exam: chin blisters and left ear infecti: Reason for Visit: Exam exam: chin blisters and left ear infection O has been using epi-otic and tri-otic, but not controlling it also used some pred that he had left over Vitals: 5:54pm 4/9/3 Wt: 42 lb. oz. By: JL General Appearance: BAR BCS 7 - Overweight Eyes: Corneas clear, pupils normal size, symmetrical; sclera white, no ocular discharge Ears: Left ear inflamed and canal is filled with grey moist discharge, right ear WNL to eardrum Integument: chin has multiple pustles and papular rash along lower lips and one large pustule under left eye Oral Cavity: Teeth are free from excessive tartar; gums are pink and moist; no gingivitis present Lymphatics: Lymph nodes all normal size Cardiovascular: Regular rhythm; no murmur detected; strong femoral pulses; CRT < 2 sec Musculoskeletal: Ambulates normally Gastrointestinal: Normal eliminations; palpates normally Urogenital: Owner reports normal eliminations; external genitalia appears normal; bladder palpates normally Respiratory: Lungs ascultate clear; trachea clear Neurologic: No apparent abnormalities Pain : Non painful Pyoderma chin otitis externa L, bacterial Ear cytoloty: 4+ rods, 2+ cocci, occ yeast Convenia.9ml SQ BNT cc left ear Rx Prednisone 0mg sig /2 tab PO SID x 3d then /2 EOD #4 Rx Z/D ultra dry food Rx facial wipes Duoxo, SID on chin recheck 2 weeks, may need ear C/S if not improving to refer to dermatologist if skin/ear problems continue Invoiced Items: Office Visit -- Qty: Ear Cytology -- Qty: BNT Ear Treatment -- Qty: Convenia Injection per ml -- Qty:.9 Prednisone 0mg -- Qty: 4 --Prednisone may cause increased thirst, increased urination, increased appetite, and panting. Always give with food, and give as directed. Never combine prednisone with non-steroidal anti-inflammatory drugs, such as aspirin, rimadyl (carprofen), or deramaxx (deracoxib). Media City Animal Hospital Page of 5 4/5/205 3:24 p.m.

12 --Give /2 tab daily for 3 days, then /2 tablet every other day for itching. z/d Ultra Canine 8 lb -- Qty: Unconfirmed Items: Mal-a-Ket wipes -- Qty: -- 2//202 2//202 Hospital INJO injection for vetalog 234 Ear Cytology 2//202 2//202 2//202 Animax 5 Animax(Panalog) oint. - 5ml. Bot Rx Num: 6860 Refills: 0.00 Expires: 2//203 Apply to the skin folds once or twice a day as needed for irritation. Pred 0 Prednisone 0mg 5 tab Rx Num: 6858 Refills: 0.00 Expires: 8//205 Wait for 5 days, then give one half (/2) tablet every other day for 2 weeks, then one half twice a week. 707 Convenia Injection per ml ml 2//202 2//202 0 Office Visit check skin chin blisters again and rub: check skin chin blisters again and rubbing face a lot otherwise fine on Diet California natural /2 cup BID with no treats and hasn't lost weight yet Rec continue trying. May need hypoallergenic diet Vitals: :45am 2//2 Wt: 42 lb. oz. T: 0.2 F. HR: 0 RR: 30 By: LP General Appearance: Overweight 5-7 lbs Eyes: Corneas clear, pupils normal size, symmetrical; sclera white, no ocular discharge Ears: Left ear inflamed. Scopes moist yellowish discharge and inflamed canal. Right ear scopes normal Integument: Chin has inch diam area of red papules/follicles. Right facial fold mod inflam, 3-5 cm diam hair loss patches on dorsal abdo, ventral body is clean, tail pocket is mild inflam, O says dog loves to be rubbed back there. Interdigital right front toes mild inflam Oral Cavity: Teeth are free from excessive tartar; gums are pink and moist; no gingivitis present Lymphatics: Lymph nodes all normal size Cardiovascular: Regular rhythm; no murmur detected; strong femoral pulses; CRT < 2 sec Musculoskeletal: Ambulates normally Gastrointestinal: Normal eliminations; palpates normally Urogenital: Owner reports normal eliminations; external genitalia appears normal; bladder palpates normally Respiratory: Lungs ascultate clear; trachea clear Neurologic: No apparent abnormalities Pyoderma secondary to allergies Convenia inject. :.9mL SQ Vetalog inject.: 0.75mL SQ (2:04PM 2//2 Briana Guadiana) ear cytology Left ear 2+ yeast Rx Pred 0 mg #5 Sig wait 5 days, then give one half eod Animax for tail and facial fold Media City Animal Hospital Page 2 of 5 4/5/205 3:24 p.m.

13 O has otomax and ear flushing solution to clean and med left ear once a day for a week then flush weekly. To see dermatologist in new year discussed atopica food trial allergy testing desensitization Invoiced Items: Office Visit -- Qty: Ear Cytology -- Qty: Convenia Injection per ml -- Qty: Prednisone 0mg -- Qty: 5 --Wait for 5 days, then give one half (/2) tablet every other day for 2 weeks, then one half twice a week. Animax(Panalog) oint. - 5ml. -- Qty: --Apply to the skin folds once or twice a day as needed for irritation. 9/8/202 8/4/202 5/29/202 Patient check-in Dr:JL: Patient check-in Dr:JL Notes:Exam- limping favoring right front paw Appointment notes for Dr:JL Notes:Exam- limping favoring right front paw Office Visit Amt:57 Dr:JL Prednisone 0mg #969 Qty:0 Amt:6.4 Dr:JL Notes:Give /2 a tablet orally every other day for this week. Then every 3 days after. Patient check-in Dr:JL: Patient check-in Dr:JL Notes:Exam- itchy Appointment notes for Dr:JL Notes:Exam- itchy Office Visit Amt:57 Dr:JL Convenia inj. 2-40lbs Amt:90 Dr:JL Ear Cytology Amt:43 Dr:JL TriOtic(Otomax) Oint. 5 mg.(generic) # Amt:24 Dr:JL Notes:Apply to left ear twice a day for 7 days then once a day for 7 days Epi Otic Advanced 8oz #8239 Amt:2.45 Dr:JL Notes:Use to flush ears weekly Prednisolone Tab. 5 mg. #8240 Qty:20 Amt:8 Dr:JL Notes:Give tablet orally twice a day for 3 days then tablet orally once a day for 3 days then tablet orally every other day Pyoben Shampoo 8oz #824 Amt:7.07 Dr:JL Notes:Use to bathe pet weekly Pill Pocket K9 Duck Tabl (25) Amt:7.5 Dr:JL : fo: : follow up 5/29/202 Patient check-in Dr:JL: Media City Animal Hospital Page 3 of 5 4/5/205 3:24 p.m.

14 Patient check-in Dr:JL Notes:follow up Appointment notes for Dr:JL Notes:follow up Office Visit, Follow-Up Amt:30.5 Dr:JL Cytology (In-House) Amt:40 Dr:JL Prednisolone Tab. 5 mg. #6093 Qty:5 Amt:9.5 Dr:JL Notes:Give tablet orally every other day for 7 days then tablet orally every 3 days 5/0/202 : ex: : exam 5/0/202 Patient check-in Dr:JL: Patient check-in Dr:JL Notes:exam Appointment notes for Dr:JL Notes:exam Pill Pocket K9 Duck Tabl (25) Qty:2 Amt:4 Dr:JL Office Visit Amt:56 Dr:JL Convenia inj. 2-40lbs Amt:90 Dr:JL Prednisolone Tab. 5 mg. #565 Qty:20 Amt:22 Dr:JL Notes:Give tablet orally twice a day for 3 days then tablet orally once a day for 3 days then tablet orally every other day Animax (Panalog) oint. 7.5ml. #566 Amt:7.5 Dr:JL Notes:Apply to Right ear twice a day for 7 days then once a day for 7 days /28/20 : fo: : follow up /28/20 /4/20 Patient check-in Dr:JL: Patient check-in Dr:JL Notes:follow up Appointment notes for -28- Dr:JL Notes:follow up Office Visit, Follow-Up Amt:30.5 Dr:JL Ivomec oral (Ivermectin) #5035 Qty:30 Amt:63 Dr:JL Notes:Give ml orally once daily for 30 days. Skin Scraping Amt:59 Dr:JL Patient check-in Dr:JL: Patient check-in Dr:JL Notes:recheck skin Appointment notes for -4- Dr:JL Notes:recheck skin Office Visit, Follow-Up Amt:30.5 Dr:JL Convenia inj. 2-40lbs Amt:97 Dr:JL 0/3/20 : ex: Media City Animal Hospital Page 4 of 5 4/5/205 3:24 p.m.

15 : exam- blister under lower lip 0/3/20 Patient check-in Dr:JL: Patient check-in Dr:JL Notes:exam- blister under lower lip Appointment notes for 0-3- Dr:JL Notes:exam- blister under lower lip Office Visit Amt:56 Dr:JL Skin Scraping Amt:59 Dr:JL Convenia inj. 2-40lbs Amt:97 Dr:JL Ivermectin 50 ml Amt:78 Dr:JL Notes:Give 0.3 mls orally once daily for 2 days, then 0.6 mls once daily for 2 days, then 0.9 mls once daily for month. TriOtic(Otomax) Oint. 7.5 mg.(generic) Amt:7.5 Dr:JL Notes:Apply to skin folds and chin once daily. Pyoben Shampoo 8oz Amt:7.07 Dr:JL Notes:Shampoo Daisy weekly. Allow 0 minutes of contact time before rinsing. Media City Animal Hospital Page 5 of 5 4/5/205 3:24 p.m.