HASIL PEMERIKSAAN LABORATORIUM

LABORATORY TEST RESULT

No. Reg/Reg. No. : SP220120112195518 Instansi/Institution : General

Nama/Name : FICKY DIMA NUARY NIK/ID No. : 3372057001880006
Tanggal Lahir/DOB : Jan, 30 1988 No. Passport/Passport No. :
Jenis Kelamin/Sex : Female Kewarganegaraan/Nationality. : Indonesia
Waktu Sampling/Date Collected : June, 15 2021 Alamat/Address : Sumber Tapen, RT: 001, RW: 003,
Waktu Periksa/Date Received : June, 15 2021 Sumber, Banjarsari, Surakarta
Waktu Selesai/Date Reported : June, 15 2021 Faskes Asal/Health Facility : Speedlab Indonesia
Jenis Sample/Sample Type Kota/City : South Jakarta
1. Orofaring & Nasofaring
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
Reverse Transcriptase Polymerase Chain
2019-nCoV Negative Negative
Reaction (RT-PCR)
Reverse Transcriptase Polymerase Chain
VIC / N gene Undetection Undetection / Ct>=35
Reaction (RT-PCR)
Reverse Transcriptase Polymerase Chain
FAM / ORF1ab Undetection Undetection / Ct>=35
Reaction (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.

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.

Petugas Pemeriksa/Investigator : JEFFRY BROMO AGENG PURBA South Jakarta, 15 June 2021

QRCODE RESULT
Dokter Pemeriksa/Physician Examiner

dr. Donatila Mano S, SpMK