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AD.12. Sithara Jayathunga - Mr Alan Marco


Dr Cyril John

Local General Practitioner

The Hail Land Medical Clinic


New Zealand

20 July 2019

Dear Dr John,

Re: Mr Alan Marco, aged 38

I am requesting an urgent visiting consultation and appropriate management for Mr Marco, who has provisionally

diagnosed with localized right external ear infection along with uncontrolled hyperglycemia.

Mr Marco presented to the Holiday Resort for a-two-week holiday and was participating in scuba diving and

swimming in daily basis. During the stay, he has been suffering from severe right ear pain which has not responded

to paracetamol, for the last five days. In addition to that sugar levels are currently unstable.

On assessment today, the ear pain still persists with warm to touch and shows tenderness when palpating. External

ear seems to be red but has no discharges. Despite the redness, the ear canal is swollen. Also, the tympanic

membrane looks pale in color. The pain was assessed four out of ten on a scale and ibuprofen was prescribed. In

spite of that, refraining from inserting cotton balls into the affected ear and swimming activities was advised. Blood

sugar levels have been monitored regularly.

Mr Marco has been treated for type 1 diabetes, for which he routinely takes insulin. He has been smoking ten

cigarettes per day.

Based on the aforementioned circumstances, immediate examination for a formal diagnosis of Mr Marcos’s health

condition would be extremely beneficial. Also, effective pain management and review of insulin therapy will be


If any information is required, please do not hesitate to contact me.

Yours sincerely,


Holiday Resort

Bayline Road


New Zealand


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