Tanggal Bulan Tahun

02 08 21

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

1 Ni Luh Sri Yastini Female 10/5/1997 23
2 I Wayan Adi Sukarnawa Male 21-Jun-87 34
3 Ni gusti Nyoman Juliarti Female 26-Jul-82 39
4 I Gede Sumantara Male 11-Feb-90 31
5 Rahman Male 23-Sep-74 46
6 Dewa Nyoman Sidan Adhi Wiguna Male 26-Sep-85 35
7 I Wayan Agustina Male 20-Aug-80 40
8 I Kadek Aryanto Male 14-Feb-84 37
9 121
10 121
 Cabang Lokasi
Clinic 24 Hours Ubud

Alamat No Handphone Nama Dokter Nama Perawat

Banjar Bengang 081337747642 dr. Tibu Bening Dikyawan
Br. Kutampi Kaler Nusa penida 082144114137 dr. Tibu Bening Dikyawan
Abang, Karangasem 081239134384 dr. Tibu Bening Dikyawan
Br. Telutug Sibetan 083119222242 dr. Tibu Bening Dikyawan
Jl. Werkudara, Gg. III Lingkungan Pande 085903716842 dr. Tibu Bening Dikyawan
Br. Sasih Batubulan 082144800555 dr. Tibu Bening Dikyawan
Br. Kutampi , Nusa Penida 087857372950 dr. Tibu Bening Dikyawan
Br. Kutampi , Nusa Penida 081378635017 dr. Tibu Bening Dikyawan
dr. Tibu Bening Dikyawan
dr. Tibu Bening Dikyawan
Nama Analis Tgl Sampling DMY Lab Order Patient ID Tgl Print DMY Hasil Test
Dikyawan ### 21 21080221 ### Negative
Dikyawan ### 22 21080222 ### Negative
Dikyawan ### 23 21080223 ### Negative
Dikyawan ### 24 21080224 ### Negative
Dikyawan ### 25 21080225 ### Negative
Dikyawan ### 26 21080226 ### Negative
Dikyawan ### 27 21080227 ### Negative
Dikyawan ### 28 21080228 ### Negative
Dikyawan ### 29 21080229 ### Negative
Dikyawan ### 30 21080230 ### Negative
 CERTIFICATE OF LABORATORY EXAMINATION

Lab order no. : 21 Patient ID : 21080221

Name : Ni Luh Sri Yastini Company : UbudCare Clinic 24 Hours
Date of Birth : 10/5/1997 (23 y.o.) Doctor : dr. Tibu Bening
Gender : Female
Drawn date : 8/2/2021
Address : Banjar Bengang

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. : 22 Patient ID : 21080222

Name : I Wayan Adi Sukarnawa Company : UbudCare Clinic 24 Hours
Date of Birth : 6/21/1987 (34 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Br. Kutampi Kaler Nusa penida

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. : 23 Patient ID : 21080223

Name : Ni gusti Nyoman Juliarti Company : UbudCare Clinic 24 Hours
Date of Birth : 7/26/1982 (39 y.o.) Doctor : dr. Tibu Bening
Gender : Female
Drawn date : 8/2/2021
Address : Abang, Karangasem

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. : 24 Patient ID : 21080224

Name : I Gede Sumantara Company : UbudCare Clinic 24 Hours
Date of Birth : 2/11/1990 (31 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Br. Telutug Sibetan

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. : 25 Patient ID : 21080225

Name : Rahman Company : UbudCare Clinic 24 Hours
Date of Birth : 9/23/1974 (46 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Jl. Werkudara, Gg. III Lingkungan Pande

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. : 26 Patient ID : 21080226

Name : Dewa Nyoman Sidan Adhi Wiguna Company : UbudCare Clinic 24 Hours
Date of Birth : 9/26/1985 (35 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Br. Sasih Batubulan

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. : 27 Patient ID : 21080227

Name : I Wayan Agustina Company : UbudCare Clinic 24 Hours
Date of Birth : 8/20/1980 (40 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Br. Kutampi , Nusa Penida

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. : 28 Patient ID : 21080228

Name : I Kadek Aryanto Company : UbudCare Clinic 24 Hours
Date of Birth : 2/14/1984 (37 y.o.) Doctor : dr. Tibu Bening
Gender : Male
Drawn date : 8/2/2021
Address : Br. Kutampi , Nusa Penida

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. : 29 Patient ID : 21080229

Name : 0 Company : UbudCare Clinic 24 Hours
Date of Birth : 12/30/1899 (121 y.o.) Doctor : dr. Tibu Bening
Gender : 0
Drawn date : 8/2/2021
Address : 0

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. : 30 Patient ID : 21080230

Name : 0 Company : UbudCare Clinic 24 Hours
Date of Birth : 12/30/1899 (121 y.o.) Doctor : dr. Tibu Bening
Gender : 0
Drawn date : 8/2/2021
Address : 0

Laboratory Testing Result

Analyte Result Unit Reference Range

Immunoserology

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

Ubud , 8/2/2021 Authorized by : Dikyawan