THE GOVERNMENT OF ROTE NDAO REGENCY

HEALTH DEPARTMENT
PUSKESMAS DELHA
(LOCAL GOVERNMENT CLINIC OF DELHA)

To whom it may concern,

Regarding:
GIULIO TONELLI
VIA VALVASSORI PERONI, 66
20133 MILANO
ITALY
On 20th August 2016, Giulio Tonelli Injured himself on the rocks while swimming in Bo’a
Beach. The resulting injury to his left leg required to be cleaned and given some antibiotics
orally and injection. As a result of this I am recommending that Giullio seek further medical
attention when he returns to Italy.

If more information is needed please contact me at ph. +6281286134690.

Sincerely,

dr. Ani Setiawati

Sedeoen,West Rote, NTT,Indonesia
NIP. 196702122009042001
 THE GOVERNMENT OF ROTE NDAO REGENCY
HEALTH DEPARTMENT
PUSKESMAS DELHA
(LOCAL GOVERNMENT CLINIC OF DELHA)

To whom it may concern,

Regarding:
PAUL SHAMBROOK
12 Blackwood court, Ansons Bay,Tasmania.
AUSTRALIA

I have examined Mr.Paul Shambrook who cut his left big toe on a rock on 2/7/2017.
He has been treated 3 times in Ba’a Hospital on 2/7/2017 and 7/7/2017, and on 10/7/2017
the wound was debrided by the visiting surgeon. who recommmended “modern
dressings” and possibly surgery i n Bali or Australia.
The wound is infected and Necrotic, and not improving.
Mr. Shambrook needs to return to Australia immediately for further treatment.

If more information is needed please contact me at ph. +6281286134690.

Sincerely,

dr. Ani Setiawati

Sedeoen,West Rote, NTT,Indonesia
NIP. 196702122009042001
 PEMERINTAH KABUPATEN ROTE NDAO
KECAMATAN ROTE BARAT
PUSKESMAS DELHA

SURAT KETERANGAN
NOMOR:440/01/PD/VII/2017

Yang Bertanda tangan dibawah ini :

Nama : Ani Setiawati

Jabatan : Dokter Umum di Puskesmas Delha

Alamat : Desa Sedeoen,Kecamatan Rote Barat,

Kabupaten Rote Ndao,NTT.
Menerangkan bahwa :
Nama : Ross Bigelow

Jenis Kelamin : Laki-laki

Nomor Pasword : E 3082947

Menerangkan Bahwa Benar nama tersebut diatas adalah Warga Negara Australia yang selalu datang dua
kali dalam setahun, berkunjung di Desa Nemberala, Kecamatan Rote Barat dan setiap kali berkunjung
yang bersangkutan membawa sejumlah kacamata baca untuk disumbangkan secara Cuma-Cuma/gratis
Kepada warga Desa Nemberala dan warga Desa tetangga lain yang membutuhkan.

Demikian Surat Keterangan ini dibuat dengan sebenarnya untuk dapat dipergunakan seperlunya.

Sedeoen, 11 Juli 2017

Mengetahui

dr. Ani Setiawati

Sedeoen,Rote Barat,NTT,Indonesia
NIP. 196702122009042001
To whom it may concern,
Regarding:
GIULIO TONELLI
VIA VALVASSORI PERONI, 66
20133 MILANO
ITALY
On 20th August 2016, Giulio Tonelli Injured himself on the rocks while swimming in Bo’a
Beach. The resulting injury to his left leg required to be cleaned and given some antibiotics
orally and injection. As a result of this I am recommending that Giullio seek further medical
attention when he returns to Italy.

If more information is needed please contact me at ph. +6281286134690.

Sincerely,

dr. Ani Setiawati

Sedeoen,West Rote, NTT,Indonesia
NIP. 196702122009042001
 THE GOVERNMENT OF ROTE NDAO REGENCY
HEALTH DEPARTMENT
PUSKESMAS DELHA
(LOCAL GOVERNMENT CLINIC OF DELHA)
Sedeoen Village, No.1, RT 001-RW 01
Subdistrict of West Rote, Rote Ndao Regency
Province East Nusa Tenggara Timur, Cp 859-82

To Whom it May Concern,

Regarding:
TREVOR STEWART
5 Ajax Ave, Nelson Bay, NSW.
AUSTRALIA 2315
Phone : +621 4981 4286

On 10th October 2017, In Bali, Trevor hit his right leg against the sharp corner of bed resulting in
a skin laceration which became infected and resulted in severe swelling of the leg. In Rote
Island, doctor Ani has carried out medical care to him berween the dates 13th October 2017 and
16th October 2017. Trevor took the antibiotic pills, because the injury was infected.
After taking the medicines, the injury has not yet to begin to heal. As a result of this, I am
recommending that Trevor return immediately to Australia to obtain further medical attention.

If more information is needed please contact me at ph. +6281286134690.

Sincerely,

dr. Ani Setiawati

Sedeoen,West Rote, NTT,Indonesia
NIP. 196702122009042001
 THE GOVERNMENT OF ROTE NDAO REGENCY
HEALTH DEPARTMENT
PUSKESMAS DELHA
(LOCAL GOVERNMENT CLINIC OF DELHA)
Sedeoen Village, No.1, RT 001-RW 01
Subdistrict of West Rote, Rote Ndao Regency
Province East Nusa Tenggara Timur, Cp 859-82

To Whom it May Concern,

Regarding:
JEFFREY LAWRENCE RYAN
13/397 BARRENJOEY ROAD NEWPORT, NSW
AUSTRALIA 2106
Phone : +61 406507507
Passport Number : PA 9578692

On 25th July 2018, Jeffrey Lawrence Ryan had an accident during a surfing incident. Jeffrey
incurred a damage to his left rib number 9 without any complication.
After a visit to the surgeon on 26 th July 2018 in Baa Hospital Rote Island, Jeffrey is cleared to
fly on an air craft on 30 th July 2018 or after to Sydney Australia.
I recommend that Jeffrey Lawrence Ryan seek additional medical attention upon return to
Australia.
If more information is needed please contact me at ph. +6281286134690.

Sincerely,

dr. Ani Setiawati

Sedeoen,West Rote, NTT,Indonesia
NIP. 196702122009042001
 THE GOVERNMENT OF ROTE NDAO REGENCY
HEALTH DEPARTMENT
PUSKESMAS DELHA
(LOCAL GOVERNMENT CLINIC OF DELHA)
Sedeoen Village, No.1, RT 001-RW 01
Subdistrict of West Rote, Rote Ndao Regency
Province East Nusa Tenggara, Cp 859-82

To Whom it May Concern,

Regarding:
MARIA CRISTINA MURTRA SADA
CALLE REPARTIDOR #32, PISO BAJOS 2A,
08023 BARCELONA, SPAIN
Phone : +34686937913

On 04th August 2018, I examined Maria Cristina, 40 years old, who had following symptoms;
diarhea, nausea, headache, abdomen discomfort, vertigo, constipation, high fever and weakness.
These conditions were extremely serious as she was dehydrated.
I diagnosed her suspected colitis acute and also stomach ulcer.
I gave her medication starting on 04th August 2018 and monitored a drip and her condition
continually until the 09 th August 2018.
And then I prescribe her medicines as followed :
1. Clanexi tab 500mg X/ 3dd I / 3 x I
2. Ultilox Syrup Forte Fl I/ 3 dd Cth I/ 3 Cth I
3. Propepsa Syrup Fl I/ 3 dd Cth I/ 3 Cth I
4. Buscopan Plus Tablet X/ 3 dd tab I/ 3 x I
5. Zollosid Capsule VII/ 1 dd Cap I / 1 x I
6. Mediammer B6 Tablet X/ 3 dd tab I / 3 x I
7. Synbio Capsule X/ 1 dd tab II / 1 x II
8. Wiacid Tab VI / 2.I
9. Ampicillin No.2 Vial / 2 gr /IV
10. Ondavell Ampul No. I / IV
11. Tramal Ampul No. II / IV
12. Neurobion Ampul No. II/ IV
13. Acran Ampul No. I
He have much improved. If her symptoms return, I recommend she seeks medical attention when
she return to Spain.
If more information is needed please contact me at ph. +6281286134690.
Sincerely,

dr. Ani Setiawati

Sedeoen,West Rote, NTT,Indonesia
NIP. 196702122009042001
 THE GOVERNMENT OF ROTE NDAO REGENCY
HEALTH DEPARTMENT
PUSKESMAS DELHA
(LOCAL GOVERNMENT CLINIC OF DELHA)
Sedeoen Village, No.1, RT 001-RW 01
Subdistrict of West Rote, Rote Ndao Regency
Province East Nusa Tenggara, Cp 859-82

To Whom it May Concern,

Regarding:
LOTTE JOLIJN KARSTEN
MIDDELIE 38
1472 GP
MIDDELIE, NETHERLANDS
Phone : +31646592683

On 19th July 2018, I examined Miss Luca, 23 years old, who had following symptoms; diarhea,
nausea, fever, stomachache, headache, 2 days constipations, and weakness.
And internist doctor visited her and diagnosed her Suspected Colitis Acute and also had different
diagnosed Suspected Tifoid Fever.
I have carried out medical care to Luka between the dates 19th July 2018 to 25th July 2018. And
then I Prescribed her medicines as followed:
1. Biotichol Capsule No. XX/ 3 x I
2. Buscopan Plus Tablet No. X / 3 x I
3. Fanocid Tab 40 mg III/ 1 x I
4. Omerazole Capsule X/ 2 x I
5. Mediammer B6 Tablet No. X / 2 x I
6. Oralit No. X / 3 x I
Her Symptoms have much improved.
If her symptoms return, I recommend she seeks medical attention when she returns home to
Netherlands
If more information is needed please contact me at ph. +6281286134690.
Sincerely,

dr. Ani Setiawati

Sedeoen,West Rote, NTT,Indonesia
NIP. 196702122009042001
 THE GOVERNMENT OF ROTE NDAO REGENCY
HEALTH DEPARTMENT
PUSKESMAS DELHA
(LOCAL GOVERNMENT CLINIC OF DELHA)
Sedeoen Village, No.1, RT 001-RW 001
Subdistrict of West Rote, Rote Ndao Regency
Province East Nusa Tenggara, Cp 859-82

To Whom it May Concern,

Regarding:
BERT VEENENDAAL
4466 HWY 34
GREEN VALLEY, ONTARIO
CANADS
K0C1L0
Phone : +01 613 525 1825

On 31th of October 2018, Mr. Bert had an accident with a Scooter during a sudden down pour in
Nemberala, Rote Island. Mr. Bert hit His left leg on the sharp rock resulting big laceration right
down to the knee cup and swelling of the leg. The resulting injury to His knee required 58
stitches to be closed. In Rote island, doctor Ani has carried out medical care to Him between the
dates 31th Of October to 05th of November 2018.
Mr.Bert took the antibiotic pills and injections because the injury seemed to be infected. And
then I Prescribed His medicines as followed :
1. Clanexi Capsule 500 mg No. XX/ 3 x I
2. Voltaren Tablet 75 mg No. X / 2 x I
3. Tradosik Capsule 50 mg No. X/ 2 x I
4. Spedifen Tablet No. VI/ 3 x I
5. Mediammer B6 Tablet No. X / 3 x I
6. Synbio Capsule No. XX / 1 x I
7. Injection Cefotaxime / IV
Mr. Bert is cleared to fly on air craft on 06th of November 2018 or after to Canada
I recommend that Mr.Bert seek additional medical attention upon to Canada.
If more information is needed please contact me at ph. +6281286134690.
Sincerely,

dr. Ani Setiawati

Sedeoen,West Rote, NTT, Indonesia
NIP. 196702122009042001