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SURAT KETERANGAN VISUM ET REPERTUMKORBAN HIDUP

Departemen Ilmu Kedokteran Foren!k " Med!kole#al $IKFM%Fakulta Kedokteran Un!&er!ta Haanudd!n

Ruma' Sak!t Umum Puat Dr( )a'!d!n Sud!ro'uodo Makaar *alan Per!nt! Kemerdekaan Km( ++ Makaar ,-./0

PRO *USTITIANomor Surat Keteran#an VeR 1 2.3VRH3II3.-+0

I( Surat Perm!ntaan VeR $SPV%444444444444444444444444444444444444444444444444444444444444444444444444444444444a) Nomor SPV

------------------------------------------------------------------:A. 901 / 30 / II / 2015 / SPK.

------------------------------------------------------------------b) TanggaldanWak! SPV d"#r"ma

------------------------------------------------------------------

: T!$!% b!lan &#br!ar" a%!n d!a r"b! l"ma b#la'(!k!l d!a l#a "ga (!l!% m#n" Wak! Indon#'"aT#nga%.

------------------------------------------------------------------*) P"%ak +ang m#mb!a SPV ,(#n+"d"k): K#(ol"'"an

N#gara #(!bl"k Indon#'"a a#ra% S!la#'"S#laan #'or Koa #'ar aka''ar S#kor Koaaka''ar d"andaangan" ol#% AIPT SANS NP 4060150 An. KAP78SK AKASSAA. SPK A;.

------------------------------------------------------------------II( 5aporan V!um et Repertum444444444444444444444444444444444444444444444444444444444444444444444444444444444444

a) T#m(a Tanggal dan Wak! P#mb!aan V#: #r#m(a d" In'ala'" <or#n'"k !ma%Sak" m!m P!'a Wa%"d"n S!d"ro%!'odo =alan P#r"n"' K#m#rd#kaan K"lom##r S#b#la'aka''ar. Pada anggal !$!% &#br!ar" a%!n d!a r"b! l"ma b#la' (!k!l nol nol l#a#m(a (!l!% l"ma m#n" Wak! Indon#'"a T#nga%.

b) Id#n"a' Pa'"#n/ Korban: ,KTP/SI/Pa'(or/SPV)>.----------------------------------------------------

1. NamaKorban : JUNAEDI  .---------------------------------------------------------------------

2. Jenis Kelamin :Laki-laki.-----------------------------------------------------------------------

3. Bangsa : Indonesia.-------------------------------------------------------------------

4. Umr : Da !l" Dela#an $a"n.-----------------------------------------------

%. !eker&aan : 'iras(as)a.----------------------------------------------------------------

*. Agama : Islam.-------------------------------------------------------------------------

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+. Alama) : Jalan !a,,erekang akassar.------------------------------------------P#m#r"k'aan

1. Anamn#'"' :----------------------------------------------------------------------------------------------T#la% d"lak!kan anamn#'"' #r%ada( '#orang 8ak"-lak" b#rnama =NAI b#r!m!r 

d!a (!l!% d#la(an a%!n b#rda'arkan S!ra P#rm"naan V"'!m (ada anggal !$!%

&#br!ar" d!a r"b! l"ma b#la' (!k!l nol nol l#a #m(a (!l!% l"ma m#n" Wak!

Indon#'"a T#nga%. Korban daang d#ngan d"#man" #mann+a. Korban m#ngak!

l!ka (ada l#ngan kanan d"alam" '#$ak 'a! $am +ang '#b#l!m ma'!k !ma% Sak"

ak"ba d"b!'!r ol#% '#k#lom(ok orang +ang "dak d"k#nal. Aaln+a (a'"#n

m#nd#ngar b!n+" bom oloo? dar" kamarn+a d" lana" d!a. K#m!d"an korban (#rg"

k#l!ar k# b#randa !n!k m#l"%a '!mb#r '!ara #r'#b!. Saa '#dang b#rd"r" d" aa'

r!ma% korban k#m!d"an d"b!'!r ol#% '#k#lom(ok orang +ang "dak d"k#nal----------2. !emeriksaan Lar --------------------------------------------------------------------------------------

a. K#'adaran: Sadar (#n!% lasgo( /oma 0,ale 15 , 6 V5).---------------------------------

b. #n+! nad": T!$!% (!l!% #nam kal" (#r m#n".--------------------------------------------------------

*. P#rna(a'an: d#la(an b#la' kal" (#r m#n".-------------------------------------------------------------

d. T#kanan dara%: S#ra!' '#(!l!% (#r !$!% (!l!% m"l"m##r a"r rak'a.---------------------------

#. S!%! badan: T"ga (!l!% #nam koma #nam d#ra$a @#l'"!'.---------------------------------------

<. T"ngg" badan: S#ra!' !$!% (!l!% d!a '#n"m##r.---------------------------------------------------

g. #ra badan: #nam (!l!% d#la(an k"logram.-----------------------------------------------------------

%. Paka"an :Korban daang m#maka" o(" b#rarna %"am dan ba$! kao' l#ngan (#nd#k

b#rarna b"r! m!da d#ngan !l"'an %"nk; b#rarna (!"% d" bag"an d#(an ba$!danm#maka" *#lana ka"n (#nd#k b#rarna %"am '#ra m#maka" 'andal $#(" b#rarna

b"r!.--------------------------------------------------------------------------------------------------------------

". @"r" k%!'!': "dak ada.---------------------------------------------------------------------------------------

 $. K#(ala.----------------------------------------------------------------------------------------------------------

1. K#(ala bag"an b#ramb!: T"dak ada k#la"nan.------------------------------------------2. Wa$a%----------------------------------------------------------------------------

:T"dak ada k#la"nan. ---------------------------------------------------------k. 8#%#r  : T"dak ada k#la"nan.

l. a%! : T"dakadak#la"nan.

m. ada : T"dak ada k#la"nan.

n. P#r! : T"dak ada k#la"nan.

Ke Halaman 2: b. Denyut nadi

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o. P"nggang : T"dak ada k#la"nan.

(. okong : T"dak d"lak!kan (#m#r"k'aan.

. !b!r : T"dak d"lak!kan (#m#r"k'aan.--------------------------------------------r. Ala k#lam"n : T"dak d"lak!kan (#m#r"k'aan.--------------------------------------------'. T!lang-!lang :------------------------------------------------------------------------------------1 T!lang #ngkorak :T"dak ada k#la"nan.-------------------------------------------

2 T!lang b#lakang

--------------------------------------------------------------------:T"dak ada k#la"nan.-----------------------------------------

3 T!lang dada

--------------------------------------------------------------------:T"dak ada k#la"nan.-----------------------------------------

T!lang (angg!l

--------------------------------------------------------------------

:T"dak ada k#la"nan.--------------------------------------------------------------------. Anggoa g#rak aa'

--------------------------------------------------------------------------: Tam(ak 'a! b!a% l!ka #rb!ka (ada l#ngan kananbaa% bag"an b#lakang d#ngan (#rm!kaan l!ka#rda(a 'a! b!a% anak (ana% +ang #ran*a( (adal!ka b#r$arak ord"na !$!% '#n"m##r dar" '"k!. Ak'"'l!ka #rl#ak "ga '#n"m##r dar" gar"' #nga% !b!%.K#dalaman l!ka '!l" d"n"la". "'#k"ar gar"' baa' l!kaam(ak b#k!an dara%. S##la% o(#ra'" (#ngangkaananak (ana% am(ak 'a! b!a% l!ka #rb!ka d#ngan #("

l!ka raa #b"ng l!ka #rd"r" dar" k!l" $ar"ngan "ka dan $ar"ngan l#mak. T"dak d"#m!kan $#mbaan $ar"ngan danda'ar l!ka adala% oo.

--------------------------------------------------------------------------!. Anggoa g#rak baa% :T"dak ada k#la"nan

3. !emeriksaan labora)orim :

a. P#m#r"k'aan !r"n : T"dak d"lak!kan (#m#r"k'aan.

-----------------------------------------------------------------------------------------------------------b. P#m#r"k'aan Bolongan ara% :T"dak d"lak!kan (#m#r"k'aan.

-----------------------------------------------------------------------------------------------------------

*. P#m#r"k'aan rad"olog" :T"dak d"lak!kan (#m#r"k'aan-----------------------------------------------------------------------------------------------------------

d. 7donogram ,ka'!' g"g"): T"dak d"lak!kan (#m#r"k'aan.---------------------------------

4. ingkasan :T#la% d"lak!kan (#m#r"k'aan 'a! korban %"d!( b#r$#n"' lak"-lak" b#rnama =NAI b#r!m!r d!a (!l!% d#la(an a%!nb#rda'arkan SPV: A. 901 / 30 / II / 2015 / SPK (ada anggal!$!% &#br!ar" d!a r"b! l"ma b#la' (!k!l nol nol l#a #m(a

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(!l!% l"ma m#n" Wak! Indon#'"a T#nga%. ar" %a'"l(#m#r"k'aan d"#m!kan 'a! b!a% l!ka !'!k d#ngan anak(ana% #ran*a( d" l!ka (ada bag"an b#lakang l#ngan kananbaa%. S##la% o(#ra'" (#ngangkaan anak (ana% am(ak'a! b!a% l!ka #rb!ka d#ngan #(" l!ka raa #b"ng l!ka #rd"r"

dar" k!l" $ar"ngan "ka dan $ar"ngan l#mak. T"dak d"#m!kan $#mbaan $ar"ngan dan da'ar l!ka adala% oo.

------------------------------------------------------------------------------------  %.Diagnosis Ker&a  ,I@ @od"ng):--------------------------------------------------------------------------

• amag#: 8!ka !'!k (ada bag"an b#lakang l#ngan kanan baa%---------------------

• P#n+#bab lang'!ng ,A-1): K#r!'akan k!l" $ar"ngan d" baa% k!l" dan oo.-------

• P#n+#bab +ang m#nda'ar" ,A-2): Tra!ma a$am.-------------------------------------------

• K#adaan orb"d la"n ,): "dakada.-------------------------------------------------------------

*. !engoba)an dan )indakan :

7(#ra'" #k'rak'" kor(!' al"#n!m '#ra *!*" l!ka o(#ra'" d#ngan Na@l 0.9C danb#ad"n#..---------------------------------------------------------------------------------------------------

In<!' "ng#r 8aka d!a (!l!% ##' (#r m#n" "nra?#na----------------------------------------

In$#k'" *#<r"aDon# 'a! gram (#r d!a b#la' $am "nra?#na-------------------------------------

In$#k'" k#orola* "ga (!l!% m"l"gram (#r d#la(an $am "nra?#na------------------------------

In$#k'"#an!' oDo"d nol koma l"ma m"l"l"#r -------------------------------------------------------

. !rognosis dari #enaki) damage: a"k. 8!ka da(a '#mb!% '#m(!rna nam!nm#m#rl!kan (#raaan k%!'!' l!ka ,o(#ra'")---------------------------------------------------

5. Kesim#lan:-----------------------------------------------------------------------------------------------T#la% d"lak!kan (#m#r"k'aan 'a! korban %"d!( b#r$#n"' k#lam"n lak"-lak" b#rnama=NAI b#r!m!r d!a (!l!% d#la(an a%!n b#rda'arkan SPV: A. 901 / 30 / II / 2015/ SPK (ada anggal !$!% &#br!ar" d!a r"b! l"ma b#la' (!k!l nol nol l#a #m(a(!l!% l"ma m#n" Wak! Indon#'"a T#nga%. ar" %a'"l (#m#r"k'aan d"#m!kan 'a!b!a% l!ka #mb!' #rb!ka (ada bag"an b#lakang l#ngan kanan baa%. 8!ka da(a'#mb!% '#m(!rna nam!n m#m#rl!kan (#raaan k%!'!' l!ka dan da(am#nggangg! <!ng'"angan kanan dalam m#lak!kan ak"?"a' '#%ar"-%ar".----------------

III( PenutupDem!k!an Surat keteran#an !n! d!6uat 6erdaarkan den#an pen#ura!an 7an#e8u8ur4

 8u8urn7a dan men##unakan pen#eta'uan 7an# e6a!k46a!kn7a erta men#!n#atumpa' pada aat mener!ma 8a6atan(44444444444444444444444444444444444444444444444444444444444444444444444

1) T#m(a dan Tanggal d"k#l!arkan '!ra V#: !ma% Sak"m!m P!'a r.Wa%"d"n S!d"ro%!'odo %ar" Sab! (ada angga !$!% b!lan &#br!ar" d!a r"b! l"mab#la' (!k!l nol nol l#a #m(a (!l!% l"ma m#n" Wak! Indon#'"a T#nga%.---------

2) Nama 8#ngka( dan Nomor Ind!k K#(#gaa"an dr / drg +g d"b#r" ##nang(#la+anan k#'#%aan: o%amad S+aal N"Eam d ak"r S.K#d. @111 10 F40- - -

3) =abaan dan kom(##n'"dar" ,2): ok#r !da #(ar#m#n K#dok#ran &or#n'"kdan #d"kol#gal &ak!la' K#dok#ran n"?#r'"a' a'an!dd"n aka''ar-----------

) Tanda angan :

KeHalaman 3: tujuh Februari

KeHalaman 4: IV.Lampiran Pemerikaan

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IV( 5amp!ranPemer!kaan-----------------------------------------------------------------------------------------1) 8am("ran a'"l P#m#r"k'aan Kl"n"' :

2) 8am("ran P#m#r"k'aan Tok'"kolog" :

3) 8am("ran P#m#r"k'aan "'o(aolog" :) 8am("ran &oo----------------------------------------: 8am("ran &oo: "lam("rkan '#ban+ak

#m(a b!a% <oo b#rarna ma'"ng-ma'"ng #rd"r" dar" 'a! b!a% <oo '#l!r!% !b!% 'a!b!a% <oo r#g"onal l#ngan kanan 'a! b!a% <oo *lo'# !( l!ka (ada l#ngan kanan 'a!b!a% <oo barang b!k".----------------------------

-----------------------------------------------------------5) 8am("ran V"d#o :

6) 8am("ran la"n-la"n :

,Ak%"r dar" S!ra K##rangan)

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