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GSI Lab

Registered Office: Graha Mitra, 4th Floor, Jl. Jend. Gatot Subroto Kav. 21, Jakarta 12930, Indonesia
Lab Address: Jl. RA Kartini No 34, Cilandak Jakarta 12430, Indonesia
Instagram : @gsilab.id Email : helpline@gsilab.id
www.gsilab.id
Keputusan Direktur Jenderal Pelayanan Kesehatan Brought to you by 24/7 Helpline +62-21-8086 6080 & WA +62-821-2233-6080
Nomor: HK.02.02/I/2932/2020

Patient: Provider:
Drive Thru GSI by Medika Plaza

Corporate:

Local ID / NIK :

Date of Birth :

Telephone :

Email :

Gender :

Report # :
Customer Reference # : 10000660

Sample # : Date Received : 17-November-2020


Source : Swab, Naso-Oropharyngeal Date Reported : 18-November-2020
Date Collected : 17-November-2020

Test Result Normal Range Date Approved

PCR SARS-CoV-2 Negative Negative 17-Nov-2020


E Gene Negative Negative
E Gene Ct -
RdRp Gene Negative Negative
RdRp Gene Ct -

Approved By : dr. Siskawati Suparmin, Sp.PK.


18-November-2020

Page 1 of 1 Print Date: 18-Nov-2020

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