Republic of the Philippines

Department of Health
METRO MANILA CENTER FOR HEALTH DEVELOPMENT
LAS PIÑAS GENERAL HOSPITAL and SATELLITE TRAUMA CENTER

COVID-19 LABORATORY RESULT FORM

NAME OF PATIENT: FAUSTINO, NIELCYN GRACE, PEÑAFLOR
(Full Last Name, First Name, Middle Name)

AGE / SEX: 28 / F DATE OF BIRTH: 11/03/1992

(MM/DD/YYYY)

PATIENT LOCATION: OutPatient HOSPITAL NO.: 000000000544510

REQUISITIONER: DR. KRISTINE ANNE M. CRUSEM DATE ADMISSION: -- / --
(MM/DD/YYYY)
SPECIMEN TYPE: NPS/OPS ADDRESS: #105 Guiho St., NARRA SAN PEDRO LAGUNA
ACCESSION NO.: COV-2021-08-03188 LABORATORY NO.: COV-2021-08-03188
DATE & TIME OF SPECIMEN COLLECTION: 08/26/2021 09:00 DATE & TIME OF SPECIMEN RECEIPT: 08/26/2021 12:00
(MM/DD/YYYY HR:MIN) (MM/DD/YYYY HR:MIN)
DATE & TIME OF RELEASE OF RESULT: 08/26/2021 17:30
(MM/DD/YYYY HR:MIN)
LABORATORY TEST RESULT

LABORATORY TEST PERFORMED: SARS-CoV-2 (causative agent of COVID-19) virus

detection by Real -Time Polymerase Chain Reaction

TEST RESULT: SARS - CoV - 2 (causative agent of COVID - 19) viral RNA detected
INTERPRETATION OF RESULTS WHEN APPROPRIATE
Final Result Interpretation
SARS-CoV-2 (causative agent of COVID-19) viral RNA Positive for SARS-CoV-2 (causative agent of COVID-19)
detected
SARS-CoV-2 (causative agent of COVID-19) viral RNA not Negative for SARS-CoV-2 (causative agent of COVID-19)
detected
Invalid due to specimen quality Negative for test internal control (most likely due to poor specimen
quality)

This laboratory result should be interpreted together with the available clinical and epidemiological information.
COMMENTS:
PERFORMED BY: VERIFIED BY: NOTED BY:

VIVIEN ANGELU J. PANGANIBAN, RMT JENNALYN C. SORIANO, RMT JON PAOLO J. TAN, MD, DPSP EDNA MAY LASAP - GO, MD, FPSP
Lic No. 0093088 Lic No. 0089657 Lic No. 0108416 Lic No. 0081290
MEDICAL TECHNOLOGIST MEDICAL TECHNOLOGIST PATHOLOGIST PATHOLOGIST

*This result has been electronically signed and verified.

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