Department of Internal Medicine (Urology) Mount Elizabeth Hospital Singapore Dear dr.

Steven Chow Re : Wayan Sutrisna (m), Age : 64 years Jalan Tukad Pakerisan no.45 , Denpasar Bali Indonesia I am reffering to you, this patient with the following history and findings, for further investigation and treatment. He gets the chronic kidney failure due to stones in both kidneys. He is in terrible condition, because his urine contain w ith blood. His ureter is broken. And he feels pain in the stomach and back, espe cially when he excrete the urine. I have done the ultrasonography, blood, and urine test in Denpasar. And I have s ent the results of the test with this referral letter. He will come to Singapore on Monday, 29 October 2012 at 11.00 am. Would you mind to arrange the consultation and examination for him on the same day if possible ? We are looking forward to your reply through e-mail. Thank you for your attention and assistance. Yours sincerely dr. Putu Suryawan

Bagian Penyakit Dalam (Urology) Rumah Sakit Mount Elizabeth Singapura Yth. dr. Steven Chow Re : Wayan Sutrisna (Laki-Laki), Umur : 64 tahun Jalan Tukad Pakerisan no.45, Denpasar Bali Indonesia Saya merujuk pasien dengan riwayat penyakit dan hasil pemeriksaan berikut ini, k epada anda untuk mendapatkan pemeriksaan dan perawatan lebih lanjut. Beliau meng alami gagal ginjal yang kronis, diakibatkan oleh adanya batu ginjal di kedua bua h ginjal beliau. Beliau dalam kondisi yang buruk, karena urinenya mengandung dar ah, kerusakan ureter dan merasakan sakit pada perut dan tulang belakang terutama saat buang air kecil. Saya telah melakukan tes urine, darah, dan ultrasonografi, serta mengirimkan has il tes bersama dengan surat ini. Beliau akan berangkat ke Singapura pada hari Senin, 29 Oktober 2012 pukul 11.00 WITA. Jika memungkinkan, bisakah anda mengatur jadwal konsultasi dan pemeriksaan di hari yang sama ? Kami menunggu balasan surat anda via e-mail. Terima kasih atas perhatian dan bantuan anda.

Hormat saya, dr. Putu Suryawan

Department of Radiology Prima Medika Clinical Laboratorium Jalan Sudirman No.12 Denpasar-Bali Dear dr. Amman Re : I Gede Mahardika (m), Age : 55 years Jalan Buton no.18 Denpasar 80223 I am reffering to you, this patient with the following history and findings, for further investigation and treatment. He gets acute colicky abdominal and flank pain. Please do general abdominal ultrasonography including the kidney examinati on. Thank you for your attention and assistance. Yours sincerely, dr. Putu Suryawan

Bagian Radiologi Laboratorium Klinik Prima Medika Jalan Sudirman No.12 Denpasar-Bali Re : I Gede Mahardika (laki-laki), Umur : 55 tahun Jalan Buton no.18 Denpasar 80223 Saya bermaksud untuk merujuk pasien ini dengan beberapa riwayat penyakit yang te lah ditemukan sebelumnya, agar diperiksa lebih lanjut. Pasien menderita Kolik Ab dominal Akut dan sakit pada panggul. Tolong lakukan pemeriksaan umum pada abdomi nal dan ginjal pasien dengan ultrasonografi. Terimakasih atas perhatian saudara. Hormat saya, dr. Putu Suryawan

To Whom It May Concern This is a statement which I write after examined the patient, Wayan Sutrisna, ag e : 48 years. Address: Jalan Sumatra 34, Denpasar. After examination ,found that he isnt in good health condition (suffering fever, cough, and shortness of breat h) and cant do his duty, so need a rest for three days from 22-24 Oktober 2012. D ate for resume duty : 25 Oktober 2012.

Surat Keterangan Sakit Ini adalah pernyataan yang saya buat setelah memeriksa pasien yang bernama, Waya n Sutrisna, umur 45 tahun. Alamat: Jalan Sumatra 34, Denpasar. Setelah pemeriksa an didapatkan bahwa pasien dalam keadaan sakit (demam, batuk, dan nafas yang pen dek sehingga sulit bernafas) dan tidak dapat menunaikan tugasnya, sehingga harus beristirahat selama tiga hari : 22-24 Oktober 2012. Tanggal berakhirnya surat a dalah : 25 Oktober 2012.

CURRICULUM VITAE NAME : Putu Suryawan DATE OF BIRTH : Buleleng, 15th Agustus 1994 GENDER : Male MARITAL STATUS : Single NATIONALITY : Indonesia ADDRESS : Jalan Tukad Languan Gang.III/no.3 South Denpasar, Denpasar, Bali TELEPHONE NUMBERS : 087860611585 EDUCATIONAL BACKGROUND : TK Kumara Loka (1999-2000) SDN 1 Panjer (2000 2006) SMPN 6 Denpasar ( 2006 2009) SMAN 1 Denpasar (2009 2012) Faculty of Medicine, Udayana University (2012 2017), Bali-Indonesia PROFESSIONAL INTEREST : POST GRADUATE TRAINING : - Emergency Services Practice, held by PERKI Bali at Sanglah Genera l Hospital 2018 - First Aiding Patient, held b y TBM Janar Duta, Faculty of Medicine, Ud ayana University, 2012-2014 ENGLISH PROFICIENCY : Certificated of TOEIC and TOEFL CURRENT POSITION/EMPLOYMENT :

POST HELD From To Consultants 10 07 17 02 08 19 Professor Gynecology Gynecology

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Speciality

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Obgyn, Clinic of Candra Hotel,

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Cardiac Clinic of Kuta Bea Hotel, K

uta Cardiac REFERENCE Prof. Dr.dr Agung Januar Sanjaya, Sp.OG

Doctor of Obgyn and Gynecology Sanglah General Hospital, Denpasar Prof. Dr.dr Wiwik Sudjijanti, Sp.JP Doctor of Cardiac Sanglah General Hospital, Denpasar PROFESSIONAL EXPERIENCE : Clinic in Harrys Hotel is 57 bedded clinics. I was also responsible in emergency duities of obgyn and gynecology problems. During my job in Gynecology medic unit I have been studying the management to handle variety of complaints of sexual a nd illness of gynecology, also helping woman take a birth a baby in emergency co ndition. During my job in the departement of Cardiology of Kuta Beach Hotel, Hot el. I was a leader of the clinic and handle variety of complaints and illness, t here are some complaints in emergency condition (the clinic death, airway distur bance, helping fainting and no aware patient that have the cardiac dissorder). I acquired skills of rapid assessment/prioritization of large numbers of patients especially in the busy or full-seoson (February-April) PUBLICATION IN JOURNAL : Nila Pebriyan Suharto. The Relationship of Airway, Breathing, Circulation, Disab le (ABCD) in first aid for increasing the precentation of patient live in emerge ncy condition. Journal of Udayana University Faculty of Medicine. July 2018; 16 (1); 10-23 PAPER DELIVERED AT CONFERENCE : FUTURE PLANS: I want to gain my experience in medical experiences and their management especia lly in woman and cardiac. And I want use to my capability properly and completel y because its very important to safe the people live especially in the Emergency Departement of International Hospital. CURRICULUM VITAE NAMA : Putu Suryawan TEMPAT, TANGGAL LAHIR : Singaraja, 15 Agustus 1994 JENIS KELAMIN : Laki-laki STATUS : Belum menikah KEWARGANEGARAAN : Indonesia ALAMAT : Jalan Tukad Languan Gang.III/no.3 Denpasar Selatan, Denpasar, Bali NOMOR TELEPON : 087860611585 PENDIDIKAN : TK Kumara Loka (1999-2000) SDN 1 Panjer (2000 2006) SMPN 6 Denpasar ( 2006 2009) SMAN 1 Denpasar (2009 2012) Fakultas Kedokteran, Universitas Udayana (2012 2017), Bali-Indonesia BIDANG KEAHLIAN : PELATIHAN-PELATIHAN : Latihan Penanganan Gawat Darurat, Oleh PERKI Bali di RSUP Sanglah 2018 Pertolongan Pertama pada pasien, diselenggarakan oleh TBM Janar Duta, Fakultas K edokteran, Universitan Udayana ENGLISH PROFICIENCY : Certificated of TOEIC and TOEFL STATUS KEPEGAWAIAN :

POST HELD

Dari Sampai Posisi Consultants 10 07 17 02 08 19 Professor Gynecology Gynecology

Spesialisasi CL of

Rumah Sakit Obgyn, Clinic of Candra Hotel,

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Cardiac Clinic of Kuta Bea

Hotel, K uta Cardiac REFERENSI Prof. Dr.dr Agung Januar Sanjaya, Sp.OG Doctor of Obgyn and Gynecology Sanglah General Hospital, Denpasar Prof. Dr.dr Wiwik Sudjijanti, Sp.JP Doctor of Cardiac Sanglah General Hospital, Denpasar PENGALAMAN KERJA PROFESIONAL : Sebagai dokter klinik di Hotel Harry dengan mengani 57 pasien. Saya bertanggung jawab atas tugas gawat darurat di bidang obgyn dan gynecology. Selama bekerja di bagian Ginekologi, saya telah belajar menagani berbagai macam kasus di bidang p enyakit seksual dan ginekologi serta membantu proses kelahiran dalam kondisi dar urat. Selama bekerja di bagian kardiologi di Hotel Kuta beach, saya sebagai pimpinan k linik tersebut yang mengani berbagai masalah dan keluhan pasien, beberapa kasus dalam kondisi darurat (the clinic death, airway disturbance, helping fainting an d no aware patient that have the cardiac dissorder). PUBLIKASI PADA JURNAL : Nila Pebriyan Suharto. The Relationship of Airway, Breathing, Circulation, Disab le (ABCD) in first aid for increasing the precentation of patient live in emerge ncy condition. Journal of Udayana University Faculty of Medicine. July 2018; 16 (1); 10-23 MAKALAH YANG DIBAWAKAN SAAT SEMINAR :