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Dr. Cyril John

General Practitioner

The Hail Lord Medical Clinic

Auckland

New Zealand

20 July 2019

Dear Dr. John

Re: Mr. Alan Marco, aged 38

Thankyou for seeing Mr. Alan Marc, who had been diagnosed with localized right external ear infection and uncontrolled Blood sugar level requires, urgent consultation for proper review of insulin therapy and appropriate pain management.

Mr. Marco has been swimming and scuba diving daily for the last couple of weeks. Consequently, he complaints of severe ear ache since 5days and unstable blood sugar level. On assessment his pain scared 4/10, which was uncontrolled by paracetamol, thereforr cotton swab inserted along with water flushing inside the ear by himself. On examination vital sugar were noted within normal range however, right ear was found warm and tenderness, redness, and swelling noticed in the ear canal, pale and green coloured ibserved within tympanic membrane redness without discharged.

Mr. Marcl was advused to take care over the counter medications , subsequently, ibuprofen was commenced for mild pain . In addition ceasing of cotton ball insertion and swimming was advised. In addition, blood sugar was monitored regularly and adjusted on insulin accordingly.

He has bad type-1 diabetes mellitus which was self-managed with insulin. He also has habit of smoking which was unsuccessful to quit.

Based on the above mentioned circumstances, appropriate reviewing of insulin therapy and proper pain management would be profoundly benefecial. If you require any additional information, please do not hesitate to contact me.

Yours sincerely,

Registered Nurse

Holiday Resort

Bayline Road

Auckland

New Zealand.