LABORATORY REPORT

MRN : 00120210704398 Lab Reg. No : 2107160175

Name : Mr. YOUSA DIMAS SETIAWAN SILABAN Source : Swab, Naso- Oropharyngeal

Local ID / NIK : 1271070201930002 Collected : 16-07-2021 06:02:30 PM

Passport ID : - Validated : 16-07-2021 10:06:19 PM

Sex : Male Test Provider : Klinik Utama Insani Medical Centre
DOB / Age : 02-01-1993 / 28 Age 6 Month Referring Doctor : -
Nationality : Indonesia

Test Required Result Reference

SARS-CoV-2 Test

SARS-CoV-2 Nucleic Acid Test / RT-PCR Positive Negative

CT Value N Gene 21.138

CT Value ORF1ab 21.547

CT value S gene 21.536

Catatan
1. PCR mendeteksi materi genetik virus tanpa dapat membedakan virus hidup ataupun mati, nilai CT tidak dapat memastikan pasien
infeksius atau tidak.
2. Hasil PCR tidak dapat dibandingkan antar alat dan gen yang berbeda.
3. Nilai CT untuk menetapkan hasil positif dan negatif sesuai dengan nilai ambang yang ditetapkan masing-masing kit.
4. Nilai CT ditentukan oleh beberapa faktor, sehingga diperlukan kehati-hatian dalam menginterpretasi.
Note
1. PCR detects viral genetic material without being able to distinguish between live and dead viruses, therefore CT values cannot
confirm whether a patient is infectious or not.
2. PCR results cannot be compared between different instruments and genes.
3. The CT value for determining positive and negative results corresponds to the threshold value set by each kit.
4. The CT value is determined by several factors, so it is necessary to be careful in interpretation.

Dokter Penanggung Jawab, Pindai untuk periksa keaslian dokumen

Doctor in Charge, Scan to check document's originality
dr. Muhamad Firman Wahyudi, Sp.PK., M.Biomed

IMC LAB Simatupang IMC LAB Basuki Rahmat

Jl. TB. Simatupang No. 82B Jl. Jend. Basuki Rahmat No. 18
Jakarta Selatan Indonesia Jakarta Timur Indonesia
Telp +62 21 227 89 552 Telp +62 21 819 2222
Email : simatupang@imclab.id Email : basura@imclab.id

Validated by : SNR

Laboratory results should be discussed with the sending doctor.

The laboratory results have been verified electronically, no signature is required.