You are on page 1of 1

barcode code

No. Registrasi Laboratorium : Dokter/ Faskes


Referring DoctorPengirim
/Medical:
Laboratory Registration Number :
USR - 70230 Facility
RSUD ODSK
Sign by
Nama Pasien Tanggal swab
Patient's Name
Giovano Angelo Andrew Leiwakabessy Swab Date
16 SEPTEMBER 2021
Sign by
No. KTP Tanggal terima sampel
National Identity card :
3275110310120002 Receiving Date
16 SEPTEMBER 2021
Sign by
Passport Number Validasi Hasil
16 SEPTEMBER 2021
Other Identity card Validation Date
Sign by
…. Cetak hasil
16 SEPTEMBER 2021
Kewarganegaraan INDONESIA Print out date
Nationality Tipe Sampel Nasopharyngeal & Oropharyngeal
Age/Date of Birth 0 Sampling Type Swab
Jenis kelamin/Sex

JENIS PEMERIKSAAN HASIL Keterangan (other information) CT Value


Type of examination Result Gen Orf1ab : -
Gen N :-
SARS-COV2 NUCLEIC ACID TEST (RT -
PCR) NEGATIF Gen E :-
IC Control 25.09

Edukasi / Education
- Patuhi protokol kesehatan yang berlaku / Always follow the health protocols
- Tetap berperilaku bersih dan sehat / Keep a clean and healthy attitude
- Untuk konsultasi lebih lanjut dapat menghubungi 0812-445-8522 atau dapat melalui layanan Telemedicine kami pada
jam kerja / For further consultation, you can contact 0812-445-8522 (pada jam 08.00 am -16.00 pm)

Manado, 16 SEPTEMBER 2021


KEPALA LABORATORIUM BIOMOLEKULER
UNSRAT - PEMPROV

dr. Janno B. B. Bernadus, M.Biomed


NIP. 197010262005011003
barcode
NIP. 197010262005011003

You might also like