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Dr Cyril John

The Hailland Medical Clinic

Auckland

Newzealand

20 July 2019

Dear Dr. John

Re: Mr Alan Marco aged 38

I am referring My Marco, who is a known case of Type 1 Diabetes Mellites, self controlled with insulin; presented with right ear infection, unstable blood sugar levels and uncontrolled pain.

Mr. Marco was on a holiday trip for 2 weeks, during which, he had daily scuba diving and regular swimming. For past 5 days, he developed severe earache and unstable blood sugar levels. His pain scale was 4/10 paracetamol was given but found inespective. His vital signs were stable. Right ear was hot upon touch, tenderness noted on palpitation. Ear Canal has swelling and redness; no discharge noted. Tympanic membrane is pale green in wrove.

Recommended to take over the counter medicine due to the inespectiveness of Paracetamol and prescribed Ibuprofen for mild pain. Instructed to check blood sugar level regularly and insulin level was increased.

Kindly review his insulin therapy, pain medications and provide a formal diagnosis.

Yours sincerly

Nurse.