HASIL PEMERIKSAAN LABORATORIUM

LABORATORY TEST RESULT

No. Reg/Reg. No. : SP0402202108082010 Instansi/Institution : General

Nama/Name : ISMAIL GHOZALI NIK/ID No. : 3404132605850003
Tanggal Lahir/DOB : Mei, 26 1985 No. Passport/Passport No. :
Jenis Kelamin/Sex : Male Kewarganegaraan/Nationality. :
WaktuSampling/Date Collected : Feb, 04 2021 Alamat/Address : Jl. Mampang Prapatan XV No.8,
Waktu Periksa/Date Received : Feb, 04 2021 RT.10/RW.5, Duren Tiga, Kec. Pancoran,
Kota Jakarta Selatan, Daerah Khusus
Waktu Selesai/Date Reported : Feb, 04 2021 Ibukota Jakarta 12760
Jenis Sample/Sample Type Faskes Asal/Health Facility : Speedlab Indonesia
1. Orofaring & Nasofaring Kota/City : South Jakarta
2. Sputum
3. Saliva
DALAM KISARAN DILUAR KISARAN NILAI
PEMERIKSAAN/TEST RUJUKAN/VALUES RUJUKAN/VALUE RUJUKAN/NORMAL METODE/METHOD
WITHIN RANGE OUTSIDE RANGE RANGE
SARS-CoV-2
2019-nCoV Negative Negative Real Time RT-PCR
VIC / N gene Undetection Undetection / Ct>=35 Real Time RT-PCR
FAM / ORF1ab Undetection Undetection / Ct>=35 Real Time RT-PCR

Catatan:
- Hasil ini hanya menggambarkan kondisi saat pengambilan spesimen, Jika timbul Gejala klinis atau kontak dengan pasien terindikasi setelah pemeriksaan, silahkan menghubungi Dokter / Fasilitas
Kesehatan terdekat. Pemeriksaan Ulang dapat dilakukan berdasarkan rekomendasi dokter.
- Hasil PCR tidak dapat dibandingkan antar alat dan gen yang berbeda.

Note :
- These results only describe the conditions at which the specimen was collected, if clinical symptoms or patient contact occurred indicated after the examination, please contact the nearest doctor /
health facility. Re-checking can be done on the recommendation of a doctor.
- PCR Results cannot be compared between different instruments and genes.

Petugas Pemeriksa/Investigator : JEFFRY BROMO AGENG PURBA South Jakarta, 04 Februari 2021

QRCODE RESULT Dokter Pemeriksa/Physician Examiner

dr. Donatila Mano S, SpMK