Sally Little has been Dr A's patient since birth. Dr A recently moved to a new group practice in another town. Dr B, who has joined Dr A's old group practice, is, like Dr A, a primary care pediatrician. Sally is due for her 3-year-old well-child visit, which is provided by Dr B. During the encounter, the Littles note that Sally breathes through her mouth when sleeping and snores sometimes. Dr B notes that Sally has been treated for otitis media 3 times in the past year. Examination finds secretory otitis media of the right ear and slightly enlarged tonsils. Dr B spends 10 minutes discussing the findings, measures to prevent future ear infections, and the Littles' concerns of possible hearing loss. Ms Little requests a referral to an otolaryngologist who previously performed a tonsillectomy on Sally's older brother. Dr B agrees and arranges for a consultation.

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