Tanggal Bulan Tahun

02 08 21

No Nama (max 33 huruf) Jenis Kelamin DOB (DMY) Umur

1 Imam Sujarwo Male 8-Aug-66 55
2 I Wayan Suarnaya Male 16-Aug-79 41
3 I Made Budi Wiryadi Adnyana Male 26-Dec-91 29
4 I Ketut Suarta Male 10-Oct-73 47
5 I Dewa Putu Satria Laksana Male 12-Aug-92 28
6 I Nengah Sudiartawan Male 18-Mar-77 44
7 I Ketut Pica Widana Male 4-May-81 40
8 I Komang Bayu Kariasa Male 7-Jun-96 25
9 I Komang Hendra Male 24-Sep-85 35
10 I Nengah Suranata Male 15-Jun-70 51
 Cabang Lokasi
Clinic 24 Hours Ubud

Alamat No Handphone Nama Dokter Nama Perawat

Jln. Sentanu 33, A3, Peguyangan Kaja, D 082144911110 dr. Tibu Bening Dikyawan
Sangging, Kamasan, Klungkung 081805675584 dr. Tibu Bening Dikyawan
Sangging, Kamasan, Klungkung 082145028384 dr. Tibu Bening Dikyawan
Br. Tameng, Sukawati, Gianyar 081338500411 dr. Tibu Bening Dikyawan
Banyuning, Buleleng 081237759089 dr. Tibu Bening Dikyawan
Selisihan, Klungkung 081907118029 dr. Tibu Bening Dikyawan
Selisihan, Klungkung 081246871112 dr. Tibu Bening Dikyawan
Lingkungan Sangging, Gianyar 085882907303 dr. Tibu Bening Dikyawan
Koripan Tengah, Ds. Banjarangkan, Klun 08174720155 dr. Tibu Bening Dikyawan
Kanginan ,Ds. Pesinggahan, Klungkung 087777438473 dr. Tibu Bening Dikyawan
Nama Analis Tgl Sampling DMY Lab Order Patient ID Tgl Print DMY Hasil Test
Dikyawan ### 01 21080201 ### Negative
Dikyawan ### 02 21080202 ### Negative
Dikyawan ### 03 21080203 ### Negative
Dikyawan ### 04 21080204 ### Negative
Dikyawan ### 05 21080205 ### Negative
Dikyawan ### 06 21080206 ### Negative
Dikyawan ### 07 21080207 ### Negative
Dikyawan ### 08 21080208 ### Negative
Dikyawan ### 09 21080209 ### Negative
Dikyawan ### 10 21080210 ### Negative
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 01 Patient ID : 21080201

Name : Imam Sujarwo Company : UbudCare Clinic 24 Hours
Date of Birth : 8/8/1966 (55 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Jln. Sentanu 33, A3, Peguyangan Kaja, Denpasar

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan

Catatan Khusus :
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 02 Patient ID : 21080202

Name : I Wayan Suarnaya Company : UbudCare Clinic 24 Hours
Date of Birth : 8/16/1979 (41 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Sangging, Kamasan, Klungkung

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan

Catatan Khusus :
dobel klik dua kali dimana saja untuk memunculkan
nama di sheet
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 03 Patient ID : 21080203

Name : I Made Budi Wiryadi Adnyana Company : UbudCare Clinic 24 Hours
Date of Birth : 12/26/1991 (29 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Sangging, Kamasan, Klungkung

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan

Catatan Khusus :
dobel klik dua kali dimana saja untuk memunculkan
nama di sheet
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 04 Patient ID : 21080204

Name : I Ketut Suarta Company : UbudCare Clinic 24 Hours
Date of Birth : 10/10/1973 (47 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Br. Tameng, Sukawati, Gianyar

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized : Dikyawan

Catatan Khusus :
dobel klik dua kali dimana saja untuk memunculkan
nama di sheet
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 05 Patient ID : 21080205

Name : I Dewa Putu Satria Laksana Company : UbudCare Clinic 24 Hours
Date of Birth : 8/12/1992 (28 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Banyuning, Buleleng

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan

Catatan Khusus :
dobel klik dua kali dimana saja untuk memunculkan
nama di sheet
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 06 Patient ID : 21080206

Name : I Nengah Sudiartawan Company : UbudCare Clinic 24 Hours
Date of Birth : 3/18/1977 (44 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Selisihan, Klungkung

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan

Catatan Khusus :
amrita108
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 07 Patient ID : 21080207

Name : I Ketut Pica Widana Company : UbudCare Clinic 24 Hours
Date of Birth : 5/4/1981 (40 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Selisihan, Klungkung

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan

Catatan Khusus :
dobel klik dua kali dimana saja untuk memunculkan
nama di sheet
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 08 Patient ID : 21080208

Name : I Komang Bayu Kariasa Company : UbudCare Clinic 24 Hours
Date of Birth : 6/7/1996 (25 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Lingkungan Sangging, Gianyar

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan

Catatan Khusus :
dobel klik dua kali dimana saja untuk memunculkan
nama di sheet
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 09 Patient ID : 21080209

Name : I Komang Hendra Company : UbudCare Clinic 24 Hours
Date of Birth : 9/24/1985 (35 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Koripan Tengah, Ds. Banjarangkan, Klungkung

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan

Catatan Khusus :
dobel klik dua kali dimana saja untuk memunculkan
nama di sheet
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 10 Patient ID : 21080210

Name : I Nengah Suranata Company : UbudCare Clinic 24 Hours
Date of Birth : 6/15/1970 (51 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Kanginan ,Ds. Pesinggahan, Klungkung

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

Rapid Test {} Antigen SARS-CoV-2 Negative Negative

Ubud , 8/2/2021 Authorized by : Dikyawan