Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
1Activity
0 of .
Results for:
No results containing your search query
P. 1
Format Konsep VER BARU

Format Konsep VER BARU

Ratings: (0)|Views: 21 |Likes:
Published by Dudi

More info:

Published by: Dudi on Nov 01, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOCX, PDF, TXT or read online from Scribd
See more
See less

11/01/2012

pdf

text

original

 
Visum Et RepertumNo
mor : VER/…../
IX/2012/RUMKITHalaman 1 dari 2
KEPOLISIAN DAERAH SULAWESI SELATANBIDANG KEDOKTERAN DAN KESEHATANRUMAH SAKIT BHAYANGKARA MAKASSAR
Jl. Letjen Pol Mappaoudang No. 63 Makassar - 90223PRO JUSTITIA
VISUM ET REPERTUM
Nomor :
VER/…..../
IX /2012/RUMKIT
 
Pada hari
……..
tanggal..................................................pukul ..........................Waktu IndonesiaTengah. Saya dokter 
…………………..
dokter ................ pada Rumah Sakit BhayangkaraMakassar bertempat di Rumah Sakit Bhayangkara Makassar atas permintaaan Visum etRepertum an. Kapol yang ditandatangani oleh : Nrp. ......... Nomor . :........, tanggal .......................tentang permintaan hasil Visum et repertum, maka dengan initelah memeriksa seorang korban yang menurut surat tersebut :-----------------------------------------Nama :Umur :Jenis Kelamin : Agama :Warga Negara :Pekerjaan : Alamat :
HASIL PEMERIKSAAN ---------------------------------------------------------------------------------------------
1. KEADAAN UMUM : -----------------------------------------------------------------------------------------------a. Kesadaran:.................................................................................................................b. Denyut nadi: ..............................................................................................................c. Pernapasan: .............................................................................................................d. Tekanan darah: .........................................................................................................e. Suhu badan: ..............................................................................................................f. Pakaian: ....................................................................................................................g. Tinggi badan:
……………………………………………………………………………………..
 h. Berat badan: ............................................................................................................. i. Ciri khusus:
………………………………………………………………………………………
 2. PEMERIKSAAN FISIK -------------------------------------------------------------------------------------a. Bagian luar tubuh: -------------------------------------------------------------------------------------------1) Kepala:a.
Kepala : ……………………..…………………………………………………..……..
 b. Mata :
……………………………………………………………………………….…..
 c. Hidung:
…………………………………………………………………………………..
 d.
Telinga: …………………………………………………………………………………..
 e.
Mulut: ………………………………………………………………………………….
 f. Gigi geligi:
………………………………………………………………………………..
 2)
Leher : …………………………………………………………………………………………
 3) Bahu:
…………………………………………………………………………………………..
 4) Dada:
………………………………………………………………………………………….
 5) Punggung:
…………………………………………………………………………………..
 6) Perut:
…………………………………………………………………………………………
 7) Bokong:
……………………………………………………………………………………….
 8) Dubur:
…………………………………………………………………………………………
 9) Anggota gerak atas:.....................................................................................................10) Anggota gerak bawah .........................................................................................................11) Alat Kelamin:
……………………………………………………………………………………
 3. FAKTA DARI TULANG-TULANG : ------------------------------------------------------------------------a. Tulang tengkorak
: ……………………………………………………………………………
 
b. Tulang Belakang
: ……………………………………………………………………………
 
c. Tulang dada:
…………………..………………………………………………………………
 

You're Reading a Free Preview

Download
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->