FK Ugm Gunung Meletus 008: INTERPOL DVI Form - Unidentified Human Remains
FK Ugm Gunung Meletus 008: INTERPOL DVI Form - Unidentified Human Remains
FK Ugm Gunung Meletus 008: INTERPOL DVI Form - Unidentified Human Remains
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
ADMINISTRATIVE DATA (checklist of operations in the mortuary) Date a b c
150 Body part No Yes (specify):
24 Oktober 2017
1 2
kondisi terbakar
155 Photographs taken No Yes by:
24 Oktober 2017
1 2
04 Pathologist name
Street / No.
Postcode / Town
State / Country
Phone / Email
02 Odontologist name
Street / No.
Postcode / Town
State / Country
Phone / Email
Enclosed Not
CHECKLIST OF CONTENTS Remarks
complete available
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
EFFECTS a b c
300 Clothing Items No: 1 Type 2 Colour 3 Label 4 Material
Head
101 penutup kepala merah, putih Indonesia, Ruff kain
and neck
101 Headcover
102 Scarf 102 syal merah, putih Indonesia, Ruff kain
103 Tie
199 Other 199 kacamata hitam, ujung merah NB plastik
Upper part of the
body and arms 209 kemeja hitam, putih, motif Ettore Bugatti kain katun
201 Blouse
202 Braces 210 kaos putih Logo EXO kain katun
203 Brassiere
204 Cardigan
205 Coat 299 jam tangan hitam, silver Rip Curl karet, stainless stel
206 Gloves
207 Overcoat
208 Pullover 301 sabuk biru donker & muda pola garis 3 kain anyaman
209 Shirt
210 T-shirt 302 celana pendek hitam, abu-abu kiri logo Harley Dav kain
211 Undershirt
212 Waistcoat
299 Other 304 kaos kaki putih Reebok kain
Lower part of the 308 celana panjang merah maroon Lee Cooper chinos
body and legs
301 Belt 309 underpants putih GT Man kain
302 Shorts
303 Skirt
304 Socks
305 Stockings
306 Swimming attire
307 Tights
308 Trousers
309 Underpants
399 Other
Only use these colours: Black, Blue, Brown, Green, Grey, Orange, Pink, Purple, Red, White, Yellow, Unknown.
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
EFFECTS a b c
310 Watch No: 1 Make 2 Model 3 Colour 4 Material 5 Inscription
01 Digital wristwatch 02 Thailand Rip Curl hitam, silver stainless steel A2591
02 Analog wristwatch
03 Digital/analog w.
Left Right Outside Inside
04 If wristwatch, worn on 1 2 3 4
Leather Metal Rubber Other (specify):
05 Watch strap/chain 1 2 3 4
Where worn:
06 Watch, other type
Only use these colours: Black, Blue, Brown, Green, Grey, Orange, Pink, Purple, Red, White, Yellow, Unknown.
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
EFFECTS a b c
340 Identity documents No: 1 Nationality 2 Number 3 Details 4 Biometrics 5 Chip
01
01 Bank cards
02 Driving licence 02
03 Identity card
04 Passport
99 Other
345 Effects No: 1 Make 2 Model 3 Colour 4 Material 5 Serial No. 6 Markings
01 Badges/keys
02 Bum bag
03 Currency
04 Diary/agenda
05 Purse
06 Ticket
07 Wallet
99 Other
350 Electronic devices No: 1 Make 2 Model 3 Colour 4 Material 5 Serial No. 6 Markings
01 Camera
02 Mobile phone
03 Music player
04 SIM
05 Tablet/handheld
06 Video
99 Other
Only use these colours: Black, Blue, Brown, Green, Grey, Orange, Pink, Purple, Red, White, Yellow, Unknown.
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
BODY DESCRIPTION (external) a b c
402 State of the body Complete Incomplete
1 2
404 Specific details No: 1 Scars 2 Piercings 3 Tattoos
Head and neck
01 Head
02 Neck
Torso
03 Torso front
04 Torso back
05 Genitalia
06 Buttocks
Upper limbs
07 Right upper arm
08 Left upper arm
09 Right forearm
10 Left forearm
11 Right hand No: 4 Skin marks 5 Malformations 6 Amputations
12 Left hand
Lower limbs
13 Right thigh
14 Left thigh
15 Right knee
16 Left knee
17 Right lower leg
18 Left lower leg
19 Right foot
20 Left foot
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
BODY DESCRIPTION (external) a b c
424 Eyebrows No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
432 Nose No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
436 Facial hair Shaved Moustache Goatee Whiskers Full beard Other (specify on
page 700's)
1 2 3 4 5 6
01 Type
Blond Brown Black Red
02 Colour 1 2 3 4
Grey White Mixed grey Other (specify):
5 6 7 8
444 Mouth/teeth No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
448 Lips No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
452 Chin No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
456 Neck No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
460 Hands/nails No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
464 Feet/nails No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
468 Body/pubic hair No Yes (describe and use page Sup. Info. (700's) for details):
01 Distinctive feature(s) 1 2
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
BODY DESCRIPTION (fingerprint information) a b c
484 Skin type prints Epidermis Dermis
retrieved from 1 2
492 Prints recorded using Black powder & adhesive label Ink
1 2
Photograph Other (specify):
3 4
Interdigital Interdigital
LEFT RIGHT
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
PATHOLOGY a b c
510 Internal examination No: 1 Specify
Head
01 Brain
02 Neck
03 Skull
04 Other
Chest
10 Heart/vessels
11 Lungs
12 Thorax/ribs/sternum
13 Other
Abdomen
20 Appendix
21 Intestines
22 Stomach
23 Other
Other internal organs
30 Adrenals/pancreas/
Spleen
31 Genitalia
32 Kidneys/ureters/
Bladder
33 Liver/gall bladder
Skeleton/soft tissue
40 Left lower limb
41 Left upper limb
42 Pelvis
43 Right lower limb
44 Right upper limb
45 Other bones
46 Soft tissue, other
locations
47 Vertebral column
Various
50 Demonstrable
pathological
condition (e.g. heart
disease, cancer
etc.)
51 Healed fractures
52 Operations
In women
60 Births
61 Hysterectomy
62 Intrauterine contra-
ceptive devices
63 Pregnancy
01 Breast
02 Pacemaker
03 Insulin pump
04 Other surgical implants
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
PATHOLOGY a b c
520 Prostheses No Yes (specify):
1 2
525 Other artificial aids No Yes (specify):
1 2
535 Sex Male Female Undetermined Reason:
1 2 3
Specimen No.
Bone Teeth Muscle Blood Other (specify):
Type 1 2 3 4 5
Swab-card spotted with: Buccal cells Blood Tissue
6 7 8
Fresh Slight Moderate Advanced Skeletonized Burnt
State 1 2 decomp. 3 decomp. 4 decomp. 5 6
Specimen No.
Bone Teeth Muscle Blood Other (specify):
Type 1 2 3 4 5
Swab-card spotted with: Buccal cells Blood Tissue
6 7 8
Fresh Slight Moderate Advanced Skeletonized Burnt
State 1 2 decomp. 3 decomp. 4 decomp. 5 6
Specimen No.
Bone Teeth Muscle Blood Other (specify):
Type 1 2 3 4 5
Swab-card spotted with: Buccal cells Blood Tissue
6 7 8
Fresh Slight Moderate Advanced Skeletonized Burnt
State 1 2 decomp. 3 decomp. 4 decomp. 5 6
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
ODONTOLOGY a b c
610 Material present for Check Specimen taken
examination
01 Jaws with teeth Upper Lower
04 Fragments
05 Other
615 Dental images 1 Digital 2 State number of 3 Non digital 4 State number of
available
01 PA 1 2
02 BW 1 2
03 OPG 1 2
04 CT 1 2
05 Other radiographs 1 2
06 Photographs 1 2
02 Other details
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
ODONTOLOGY
630 Dental findings (for primary teeth change specific FDI code)
11 21
12 22
13 23
14 24
15 25
16 26
17 27
18 28
RIGHT
LEFT
48 38
47 37
46 36
45 35
44 34
43 33
42 32
41 31
635 Specific data 1 Crowns 2 Pontics 3 Implants a b c
01 Specify 4 Dentures 5 Other
640 Other findings 1 Occlusion 2 Tooth wear 3 Periodontal status
01 Specify
4 Supernumeraries 5 Stains 6 Other
645 Type of dentition
Date: Signature:
SUPPORTING INFORMATION (if referring to data given on a previous page, please indicate field number)
700 1 Field No. 2 Description
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)
805 APPENDIX DNA a b c
810 Typing Laboratory Name:
RSUP dr. Sardjito
Email:
Address:
D21S11 12 14
FGA 12 14
D3S1358 11 12
D18S51 12 15
CSF1PO 11 12
D5S818 11 12
D16S539 9 11
Penta D 15 17
Penta E 11 14
D2S441
D10S1248
D22S1045 18,19 16,17 18,19
D12S391
SE33
D6S1043 18,19
Add any information not represented of the markers above, using c-column/page 700's Supporting information.
RIGHT
LEFT