Looking at the handwritten note, this appears to be a lab requisition/order sheet listing tests:

So the circled item is a Methotrexate level test - a blood test used to measure the concentration of methotrexate (a chemotherapy/immunosuppressant drug) in the blood. This is typically ordered to:

I want to flag some uncertainty here: the handwriting is quite messy, and while "Methotrexate" fits well with the circle shape and the "level" annotation next to it (methotrexate levels are a very standard clinical lab order paired with ESR/CRP in inflammatory or oncology workups), I can't be 100% certain from the image alone. If you can confirm the clinical context (e.g., is this from an oncology, rheumatology, or nephrology encounter?), I can verify this reading with more confidence.

Given the ENT (Ear, Nose, Throat) context you mentioned, I need to revise my earlier guess.

Looking at the note again with that context in mind:

Methotrexate level doesn't fit an ENT setting well - that test is mainly ordered in oncology/rheumatology to monitor drug toxicity. In an ENT context, ESR and CRP are most commonly paired with a Procalcitonin level, since that combination is the standard inflammatory/infection marker panel used for conditions like:

Procalcitonin specifically helps distinguish bacterial from viral/other causes and gauge infection severity, which is why it's frequently ordered alongside ESR/CRP in ENT infectious workups.

That said, I have to be upfront: the handwriting in the circle is genuinely difficult to make out with certainty, and I could not get a clean re-read of it beyond my own visual reading. My best-supported reading given the ENT context is "Procalcitonin level," but I'm not fully certain - if you can tell me anything else about the clinical scenario (e.g., is this for a suspected abscess/infection, or for a vasculitis workup like GPA affecting the nose/sinuses/ears), I can narrow it down further.