CONFIDENTIAL MEDICAL REPORT

Date: 16/3/2019 Time: 11.30 pm

File No. : 321/SBKR/2019

Name :
Sex : FEMALE
Age :
Nationality : FILIPINA
Current Address in Bali : BeachWalk Shoping Mall

Present history:
Patient suddenly faint while walking on the beachwalk. And then, patient is appointed by security guard.
After given by oxygen, patient is aware but she is not say what caused the collapse. Patient only said that
she had never experienced this before.

Allergic history : None

Past medical history :
Medication currently used : None
Treatment so far : none

Physical Examination:
Level of consciousness : Compos mentis Respiratory rate : 24 times per
(E4V5M6) Blood pressure: 120/80 mmHg minute Temperature : 38.90 C
Pulse rate : 124 beat per minute O2 saturation : 98% on room air

General State
Patient looked slightly unwell
Eyes : no sunken eyes, no anemic or yellow sclera, no redness at both
eyes Mouth : dry lip (-)
Throat : redness on pharynx wall (-), exudate (-)
Chest : Heart : heart sound S1 S2, single, regular, and no
murmur Lung : vesicular sound (+/+), no wheezing,
no rhonchi
Abdomen : normal bowel sound, slightly bloated (-), tenderness on epigastric area (-), skin turgor (+)
normal, no enlargement of liver or spleen
Limb : warm on all extremities, no edema, CRT = 2 seconds

Additional examination (Radiology, Lab, ECG, CT Scan, Ultra Sound, MRI, etc.): -

Diagnosis:
Fainted

Treatment/Medication

- Oksigen 4 lpm/liter
Doctor’s Recommendation:
Patient Request Repatriation: Yes No V

In Doctor’s Opinion This Patient Requires Repatriation / Medical Evacuation: Yes No V

Patient Can Be Transported: Yes V No

If Yes, with:

V Normal Transportation

Ambulance

Patient’s fit to fly: Yes V No

If Yes, with:
V
Normal Flight
V
Non Escorted In Economic

Class Non Escorted In Business

Class

Non Medical Escorted In Business

Class Medical Escort in Business

Class Stretcher Medical Escort

Team

Charter Flight / Air Ambulance Team

Comment:
- Avoid eating any spicy, greasy, and acid food; avoid drinking soda, alcohol, coffee, or tea.
- Further examination such as blood test should be done if fever persists within the next three days.
- Take the medicine as prescribed.
- If anything issues, please call us.

Kuta, 16-3-2019

dr. dewa prasatya