LABORATORIUM

Jl. Siloam No.6, Lippo Karawaci 1600, Tangerang 15811

Telp. (+62 21) 8064 6900 Fax. (+62 21) 5460 066

Clinical Pathologist: dr. David Rustandi, Sp.PK

Lippo Village dr. Tandry Meriyanti, Sp.PK

Ward : RUJUKAN Clinician: SILOAM HOSPITALS PURWAKARTA

Age / Sex DOB : 25Y / MALE Patient: APRI HANDOKO PUTRO
Order Time :08-04-1995 Address: PERUM PANORAMA BLOK E4/31
:12-01-2021 17:38:00

Specimen Recieved :13-01-2021 10:28:00 PID : 00972729

Print Date :13-01-2021 11:43 Lab No. : 21027515
Page : 1/1

T E S T RESULT UNIT REFERENCE RANGE

MOLECULAR DIAGNOSTIC

PCR SARS CoV-2

PCR SARS CoV-2 Negative Negative
Catatan :
- Hasil pemeriksaan diatas dikerjakan dengan metode Real Time PCR dan
hanya menggambarkan kondisi saat pengambilan spesimen.
- Bila memerlukan pemeriksaan lanjutan dapat dilakukan berdasarkan
rekomendasi dari klinisi.
- Siloam Hospitals Lippo Village sudah termasuk dalam jejaring
laboratorium pemeriksa Covid-19, sesuai dengan Surat Edaran KMK
No. HK.01.07/Menkes/405/2020.

Remarks :
- The test above used Real Time PCR method of testing and described
result on the day of specimen collection.
- Repeated test is performed based on clinician recommendation.
- Siloam Hospitals Lippo Village is included in the network of laboratories
for Covid-19 examination, according to Surat Edaran KMK
No. HK.01.07/Menkes/405/2020.

Authorized By dr. Tandry Meriyanti,

Sp.PK
Authorisation Date :13-01-2021 11:42:00
A laboratory assessment can only be given by a doctor who has patient clinical data.
This laboratory has been verified electronically, no signature required