CERTIFICATION OF RESULT

PATIENT NAME:

REQUESTED BY:

AGE/GENDER:

DATE REQUESTED:

COVID-19 ANTIGEN SCREENING TEST

Test Kit: PANBIO COVID-19 Ag RAPID TEST DEVICE (Nasopharyngeal)
Lot #: 41ADG127A / Sub: A Expiration Date: 2022.02.01

Result:

COVID 19-ANTIGEN

Disclaimer: Rapid Antigen Test Kits are considered screening tests only and shall not be used as a standard test to
diagnose or rule out COVID-19.

___________________________________
Authorized Signatory
 CERTIFICATION OF RESULT

PATIENT NAME:

REQUESTED BY:

AGE/GENDER:

DATE REQUESTED:

COVID-19 ANTIGEN SCREENING TEST

Test Kit: PANBIO COVID-19 Ag RAPID TEST DEVICE (Nasopharyngeal)
Lot #: 41ADG127A / Sub: A Expiration Date: 2022.02.01

Result:

COVID 19-ANTIGEN

Disclaimer: Rapid Antigen Test Kits are considered screening tests only and shall not be used as a standard test to
diagnose or rule out COVID-19.

___________________________________
Authorized Signatory
 CERTIFICATION OF RESULT

Date:___________

This is to certify that ____________________________________________________________, ___________, currently residing at

(Name of patient) (Age)

____________________________________________________________________, has undergone a rapid COVID 19 Antigen swab test using

(Address)

PANBIO COVID-19 Ag RAPID TEST DEVICE (Nasopharyngeal), a rapid chromatographic immunoassay for the qualitative

detection of specific antigens to SARS=CoV-2 present in the human nasopharynx.

□ Fever
□ Cough
□ Colds
□ Loss of taste/smell
□ Contact with a possible/confirmed case

Result:

COVID 19-ANTIGEN

Disclaimer: Rapid Antigen Test Kits are considered screening tests only and shall not be used as a standard test to
diagnose or rule out COVID-19.
 ___________________________________
Authorized Signatory

CERTIFICATION OF RESULT

Date:___________

This is to certify that ____________________________________________________________, ___________, currently residing at

(Name of patient) (Age)

____________________________________________________________________, has undergone a rapid COVID 19 Antigen swab test using

(Address)

PANBIO COVID-19 Ag RAPID TEST DEVICE (Nasopharyngeal), a rapid chromatographic immunoassay for the qualitative

detection of specific antigens to SARS=CoV-2 present in the human nasopharynx.

□ Fever
□ Cough
□ Colds
□ Loss of taste/smell
□ Contact with a possible/confirmed case

Result:

COVID 19-ANTIGEN
Disclaimer: Rapid Antigen Test Kits are considered screening tests only and shall not be used as a standard test to
diagnose or rule out COVID-19.

___________________________________
Authorized Signatory