P ost Mortem (pink)INTERPOL DVI Form - Unidentified Human Remains Odontology 600's

Odontology

Place of disaster: TASIKMALAYA PM No: ID/2010/BST/002

Natureofofdisaster:
Nature disaster: AIRWAYS AW1504 ACCIDENT
Day Month Year Male Female Other Unknown

Date of disaster: 2 0 0 1 2 0 1 8
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

02 Jaws without teeth Upper Lower

03 Teeth only FDI No's:

04 Fragments

05 Other

615 Dental images available 1 Digital 2 State number of 3 Non digital 4

Non digital State number of

01 PA 1 DSC_00127 2

02 BW 1 2

03 OPG 1 2

04 CT 1 2

05 Other radiographs 1 2

06 Photographs 1 ID/2010/BST/002 2

625 Supplementary details

01 Condition of the body

02 Other details

Registered by Duty Title : Forensic Odontologist Signature / Date

Name : Erlinda Yuly Ekasari 20-11-2022
Address : RSGM Universitas Airlangga
Phone
Phone/ /Email
Email : 081217041219
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 P ost Mortem INTERPOL DVI Form - Unidentified Human Remains
(pink) Odontology 600's
Odontology

Place of disaster: TASIKMALAYA PM No: ID/2010/BST/002

Natureofofdisaster:
Nature disaster: AIRWAYS AW1504 ACCIDENT
Day Month Year Male Female Other Unknown

Date of disaster: 2 0 0 1 2 0 1 8
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 non non 38
47 OD car OD tcf 37
46 OV car OMV goi 36
45 O car O car 35
44 OV car cca 34
43 V car V car + O att 33
42 int int 32
41 M rot + V car M rot + tcf + V car 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

01 Dentition 1 Primary dentition 2 Mixed dentition 3 Permanent dentition

647 Estimated age

Min Max Min Max
01 Age year / year month / month
(Fill either year or month)

650 Quality check Date: Signature:

FOd 1 FOd 1 Name:

Date: Signature:

FOd 2 (If available) FOd 2 Name:

Registered by Duty Title : Forensic Odontology Signature / Date

Name : Erlinda Yuly Ekasari
Address : RSGM Universitas Airlangga
Phone
Phone/ /Email
Email : 081217041219
[(EN) Version 2018] 11 of 12
 P ost Mortem information 700's
Supporting information
(pink)INTERPOL DVI Form - Unidentified Human Remains Supporting
Place of disaster: TASIKMALAYA PM No: ID/2010/BST/002
Natureofofdisaster:
Nature disaster: AIRWAYS AW1504 ACCIDENT
Day Month Year Male Female Other Unknown

Date of disaster: 2 0 0 1 2 0 1 8
a = Data not available b = Attachment c = Further info on page Sup. Info. (700's)

SUPPORTING INFORMATION (if referring to data given on a previous page, please indicate field number)
700 1 Field No. 2 Description
640 31 mesial rotation (occlusion)
33 tooth wear (occlusion)
41 mesial rotation (occlusion)

705 Additional Supporting Information page (700's) 1 No 2 Yes

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