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RS.

Premier Surabaya Laboratory Service


Jl. Nginden Intan Barat Blok B, Surabaya
East Java - Indonesia
Tel: 62-31 599 3211/5882, Fax: 62-31 599 5880/3214

Consultant: Prof.DR.Jusak Nugraha,dr,MS,Sp.PK(K)

M.R.N : 00429295 Sex : M Lab No. : 202101230180


Age : 27 D.O.B : 26/08/1993 Patient Name : Ahsan Hafidz
Location : DRIVETHRU Requesting Dr : Lydia Marchelina, dr.

Report to : Lydia Marchelina, dr.

Collection Time & Date Received in Lab Specimens received


16 : 53 23/01/2021 16 : 53 23/01/2021 SW

Cilinical Notes
-

SECRET
PCR Covid-19 (SARS-COV2) NEGATIVE (-)
Gen N2 : NEGATIVE, Value range CT (> 38.00)
Or ND
Gen RdRP : NEGATIVE, Value range CT (> 38.00)
Or ND
Gen E : NEGATIVE, Value range CT (> 38.00)
Or ND

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Authorized by : MV
Date : 24/01/2021

Print Time/Date: 13:52 25/01/2021 *** FINAL REPORT *** Time : 12 : 18


Page : 1/1

LABORATORY / PHARMACY / RADIOLOGY / AMBULANCE 24 HRS


FRM/PPM/LAB/25 Rev.00

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