Dr. Cyril John

Local General Practitioner

The Hail Land Medical Clinic

Auckland

New Zealand

20 July 2019

Dear Dr. John

Re: Mr. Alan Marco, aged 38

Thank you for accepting Mr. Alan Marco, who has been diagnosed with localised the right external ear infection (atitis media) and unstable type-1 diabetes mellitus. Ibam referring Mr. Marco's case to you, for your expert advice and management.

Today, Mr. Marco presented with the right ear pain, that wad persisted from past five days. Paracetamol was taken but no relieve from pai is noticed. Self-insertion of cotton swabs to clean the ear and flushing of water inside the ear has experienced. Vit signs reported normal. Upon impection, the right ear found warm while touching and tenderness on palpation is observed. Ear canal and external ear showed redness, swelling without ear discharge. Tympanic membrane showed pale green coloured appearance . Pain level js assessed as 4/10.

In addition, ibuprofen is commenced for mild pain. Advised to refrain cotton ball insertion and swimming. Monitoring of blood glucose level is suggested along with appropriate insulin administration according to level.

Mr. Marco account at Wellington Island came for a holiday trip with his wife for 2 weeks. He is participating in scuba diving and swimming on regular basis from past two weeks. Habit of cigarratte smoking is noted.

Based on the aforementioned circumstances cinsultation for formal diagnosis and reviewforninsulin therapu, along with pain management for Ms. Marco's health condition would be profoundly beneficial. In case you requir any additional information. Please do not hesitate to contact me.

Yours sincerely

Nurse

Holiday Resort

Bayline Road

Auckland

New Zealand.