MANDIRI HEALTH CARE

Jl.Tukad Badung XXI B No. 16 Renon, Denpasar-Bali

Telp. 081999861734 / 085238259966
Email : admin@mhc-club.com Website : www.mhc-club.com

,,MEDICAL REPORT
Laporan Pemeriksaan Kesehatan

Patient’s Family Name Mavro First Name Aaron

Nama Keluarga Nama

Date of Birth / Age 31 yo Sex Male Nationality Australian

Tanggal Lahir / Umur Jenis Kelamin Kebangsaan

Patient Location Padma Legian Resort Room #317 Phone +61 417 278 964
Lokasi Pasien Telepo
n

Patient’s History or Complaint : Patient came with the complaint that the left ear felt closed and
Riwayat penyakit pasien atau keluhan blocked since 1 day after the patient swam continuously.
Past medical history : None
Current use of medication : None
Allergic history : None

Patient Vital Signs Temp: (-) Respiration: (-) Pulse Rate: (-)
Keadaan vital pasien Suhu Pernapasan Pernapasan

BP: (-) GCS E4V5M6 SPO2 : (-)

Tekanan Darah Tingkat Kesadaran Saturasi O2

Other examination findings : Meatus Acusticus Externus (Auricula Sinistra): Earwax (+),
Hiperemi (+), Excoriasi (+)
Hasil pemeriksaan lain

Laboratory result : None

Hasil pemeriksaan laboratorium
 MANDIRI HEALTH CARE
Jl.Tukad Badung XXI B No. 16 Renon, Denpasar-Bali
Telp. 081999861734 / 085238259966
Email : admin@mhc-club.com Website : www.mhc-club.com

Diagnosis : Serumen Obsturans (Auricula Sinistra)

Diagnosa

Medication given and doses : 1. Spooling with the warm water in the left ear
Pengobatan yang telah diberikan

Doctor Recommendation :
Rokemendasi dokter 1. Follow up the condition if not be better after spooling.
2. Take the painkiller if feel pain.
 MANDIRI HEALTH CARE
Jl.Tukad Badung XXI B No. 16 Renon, Denpasar-Bali
Telp. 081999861734 / 085238259966
Email : admin@mhc-club.com Website : www.mhc-club.com

Patient can be transported / Apakah Pasien dapat diangkat Yes V No

Patient is fit to fly / Pasien mampu mengikuti penerbangan Yes V No

Patient can travel Unescorted / Pasien dapat melakukan perjalanan Tanpa pendamping Yes V No

With medical escort / Dengan pendamping medis Yes No V

With non medical escort / Pendamping non medis Yes No V

Patient need Ordinary seat / Pasien perlu tempat duduk biasa Yes V No
Wheelchair / Kursi roda Strecher case / Tandu

Foing / Expat patient asking for repatriation Yes No V

In dr’s opinion this patient requires repatriation Yes No

Rekomendasi dokter secara medis apakah memang diperlukan V

Comment :

Bali, 01 May 2022

Attending Physician,

Ni Wayan Eka Ari Sawitri, MD