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Contoh Lain Blanko VR Korban Mati

Contoh Lain Blanko VR Korban Mati

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Dipublikasikan oleh Giritama Irwantoro

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Published by: Giritama Irwantoro on Nov 27, 2012
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12/04/2012

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DEPARTEMEN KESEHATAN REPUBLIK INDONESIA

Instalasi Kedokteran Forensik
RUMAH SAKIT UMUM PUSAT..........
Jl........... Telp...........,Kota..........
Nomor :
VISUM ET REPERTUM
PRO JUSTISIA : Berdasara! s"rat perm#!taa! pe!$#d# Nama:..........
,NRP:.......... , Pa!%at:.......... , Ja&ata!:.......... ,
Nomor s"rat:.......... , Ta!%%al s"rat:.......... , maa T#m
Kedotera! 'ore!s# d#&a(a) p#mp#!a! Doter:..........
, d#&a!t" Doter:.......... , &eserta Sta* dar# Ba%#a! Ilm"
Kedotera! Ke)a#ma! 'a"ltas
Kedotera!..........+I!stalas# Kedotera! 'ore!s#
RSUP.........., pada Har#:.......... , Ta!%%al:.......... ,
m"la# P""l:..........,IB sampa# P""l:..........,IB,
mela"a! pemer#saa! l"ar + l"ar dalam serta
#de!t#*#as# d# r"a!% otops# RSUP.......... , ter)adap
almar)"m+a) Nama:.......... , Um"r:..........ta)"!, Je!#s
elam#!:.......... , A%ama:.......... , Alamat:.........., a#&at
per#st#(a:..........--------------------------------------------------
Has#l pemer#saa! #t" #ala) se&a%a# &er#"t : ------------
I PEMERIKSAAN LUAR DAN IDENTI'IKASI
. Keadaa! Je!a/a) : Je!a/a) &erla&el + t#da &erla&el, terleta d#atas me0a
otops#, d#t"t"p....................------------------------------------
1 S#ap 0e!a/a) d#atas
me0a otops#
: Terle!ta!%, de!%a! m"a me!%)adap e..........--------
2 Ka" 0e!a/a) : Ada + T#da ada, pada se!d#.......... , m"da) + s"ar
d#%eraa!.--------------------------------------------------------
3 Ber4a 0e!a/a) : Ada + T#da ada, pada.......... $a!% )#la!% + t#da )#la!%
pada pe!ea!a!.------------------------------------------------
5 Pem&"s"a! 0e!a/a) : Ada + T#da ada. -------------------------------------------------
6 U"ra! 0e!a/a) Berat 0e!a/a):..........%, Pa!0a!% 0e!a/a):..........4m.--
7 Kepala
a. Ram&"t : -----------------------------------------------------------------------
& Ba%#a! $a!%
tert"t"p ram&"t
: -----------------------------------------------------------------------
4 Da)# : -----------------------------------------------------------------------
d Mata a!a! : -----------------------------------------------------------------------
Mata #r# : -----------------------------------------------------------------------
e H#d"!% : -----------------------------------------------------------------------
* M"l"t : -----------------------------------------------------------------------
% Da%" : -----------------------------------------------------------------------
) P#p# : -----------------------------------------------------------------------
# Tel#!%a : -----------------------------------------------------------------------
8 Le)er : -----------------------------------------------------------------------
9 Dada : -----------------------------------------------------------------------
.
:
Per"t : -----------------------------------------------------------------------
.
.
Alat Kelam#! : -----------------------------------------------------------------------
.
1
A!%%ota atas a!a!
Le!%a! atas : -----------------------------------------------------------------------
Le!%a! &a(a) : -----------------------------------------------------------------------
Hal 1 No.VeR:
Ta!%a! : -----------------------------------------------------------------------
A!%%ota atas #r#
Le!%a! atas : -----------------------------------------------------------------------
Le!%a! &a(a) : -----------------------------------------------------------------------
Ta!%a! : -----------------------------------------------------------------------
.
2
A!%%ota &a(a) a!a!
Pa)a : -----------------------------------------------------------------------
T"!%a# &a(a) : -----------------------------------------------------------------------
Ka# : -----------------------------------------------------------------------
A!%%ota &a(a) #r#
Pa)a : -----------------------------------------------------------------------
T"!%a# &a(a) : -----------------------------------------------------------------------
Ka# : -----------------------------------------------------------------------
.
3
P"!%%"!% : -----------------------------------------------------------------------
.
5
Pa!tat : -----------------------------------------------------------------------
.
6
D"&"r : -----------------------------------------------------------------------
.
7
Ba%#a! t"&") $a!% la#! : -----------------------------------------------------------------------
II PEMERIKSAAN DALAM
.
8
Setela) "l#t dada
d#&"a
: -----------------------------------------------------------------------
.
9
Ja!t"!% : -----------------------------------------------------------------------
1
:
Par"-par" a!a! : -----------------------------------------------------------------------
Par"-par" #r# : -----------------------------------------------------------------------
1
.
Tes ap"!% par" I : -----------------------------------------------------------------------
Tes ap"!% par" II : -----------------------------------------------------------------------
Tes ap"!% par" III : -----------------------------------------------------------------------
1
1
Hat# : -----------------------------------------------------------------------
1
2
L#mpa : -----------------------------------------------------------------------
1
3
;#!0al a!a! : -----------------------------------------------------------------------
;#!0al #r# : -----------------------------------------------------------------------
1
5
Lam&"!%, Us"s Hal"s,
Us"s Besar
: -----------------------------------------------------------------------
1
6
Kepala : -----------------------------------------------------------------------
1
7
Le)er : -----------------------------------------------------------------------
1
8
Alat-alat dalam $a!%
la#!
: -----------------------------------------------------------------------
III PEMERIKSAAN LABORATORIUM
. ;olo!%a! dara) : A + B + AB + O
1 Alo)ol dalam dara) : -----------------------------------------------------------------------
2 Paras#tolo%# : -----------------------------------------------------------------------
3 Tos#olo%# : -----------------------------------------------------------------------
5 M#ro&#olo%# : -----------------------------------------------------------------------
6 Patolo%# A!atom# : -----------------------------------------------------------------------
I< KESIMPULAN
Hal 2 No.VeR:
. -------------------------------------------------------------------------------------------------------------
< PENUTUP
Dem##a! <#s"m et Repert"m #!# d#&"at de!%a! me!%#!%at s"mpa) pada (at"
me!er#ma 0a&ata! da! &erdasara! Lem&ara! Ne%ara No. 25: ta)"! .927 serta
U!da!%-"!da!% No. 8 ta)"! .98..---------------------------------------------------------------------
Ta!da ta!%a!,
-------------------------
NIP :
Hal 3 No.VeR:

Usus Halus. : ----------------------------------------------------------------------5 Usus Besar 2 Kepala : ----------------------------------------------------------------------6 2 Leher : ----------------------------------------------------------------------7 2 Alat-alat dalam yang : ----------------------------------------------------------------------8 lain III PEMERIKSAAN LABORATORIUM 1 Golongan darah : A / B / AB / O 2 Alkohol dalam darah : ----------------------------------------------------------------------3 Parasitologi : ----------------------------------------------------------------------4 Toksikologi : ----------------------------------------------------------------------5 Mikrobiologi : ----------------------------------------------------------------------6 Patologi Anatomi : ----------------------------------------------------------------------IV KESIMPULAN Hal 2 No.1 3 Tangan Anggota atas kiri Lengan atas Lengan bawah Tangan Anggota bawah kanan Paha Tungkai bawah Kaki Anggota bawah kiri Paha Tungkai bawah Kaki Punggung : : : : : : : : : : : --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 4 1 Pantat : ----------------------------------------------------------------------5 1 Dubur : ----------------------------------------------------------------------6 1 Bagian tubuh yang lain : ----------------------------------------------------------------------7 II PEMERIKSAAN DALAM 1 Setelah kulit dada : ----------------------------------------------------------------------8 dibuka 1 Jantung : ----------------------------------------------------------------------9 2 Paru-paru kanan : ----------------------------------------------------------------------0 Paru-paru kiri : ----------------------------------------------------------------------2 Tes apung paru I : ----------------------------------------------------------------------1 Tes apung paru II : ----------------------------------------------------------------------Tes apung paru III : ----------------------------------------------------------------------2 Hati : ----------------------------------------------------------------------2 2 Limpa : ----------------------------------------------------------------------3 2 Ginjal kanan : ----------------------------------------------------------------------4 Ginjal kiri : ----------------------------------------------------------------------2 Lambung.VeR: .

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