MEDICAL CERTIFICATE

To whom it may concern,

This is to certify, that today we have examined:
Name

: Mrs Ruth Johnston

Sex

: Female

Date of Birth

: 23/01/1962

Nationality

: Australia

Address in Bali

: Kori Ubud Resort, Ubud, Bali-Indonesia

Diagnosis:
Observasi abdominal pain ec suspect acute dyspepsia
With urinary tract infection

History Of Recent Illness:

She has been suffering from fever 2 days ago, back pain, nausea and vomitting, headache,
diarrhea She was threated on 13th April 2016. Today she feel weak, tired and feel pain on right
back

Physical Examination
Vital Sign:
Level of Consciousness

: Alert

Blood pressure

: 100/60 mmHg

Pulse

: 96 x/min

Respiratory Rate

: 18 x/min

Temperature

: 36,9C

General State
General appearance

: healthy

Eyes

: anemic -/-, icteric-/-, pupil reflex +/+ isochors

ENT

: normal

Chest

: Heart : normal, regular rhythm, no murmur.

Lung : symmetric chest expansion, clear breath sound, no rhales, no
wheezing

Abdomen

: distention, bowel sounds increasing, tenderness minimal.

Extremities

: warm extremities +/+

Management:
IVFD Ringer Lactat 30 drops perminutes than continue with Nacl 0,9 %
Ondansentron 8 mg 1 ampoul intra venously
Ranitidine 1 ampoule intra venously
Observasi @ 6 hours
Lansoprazole 20 mg BID, Scopamin tablet TID

Recommendation :
She is not fit to flight for 15th April 2016, she need resting for few more days (3-5 days)
Keep drinks a lot of water and review in case

Ubud-Bali, 15th April 15, 2016

The attending Physician

(dr Made Arisani)