No. Lab : 2104100114 Dokter : dr.

Clarissa Emiko Talitaputri

Laboratory Number Physician's name
No. MR : 00060161 Tgl Transaksi : 10-04-2021 10:56:25
Medical Record Number Transaction Date
Nama : ASEP MULYANA SANTOSA. TN Tgl Bahan Diterima :-
Patient Full Name Specimen Collection Date
Tanggal Lahir/ Umur : 22-03-1977 / 44 tahun 0 bulan 19 hari Tgl Hasil Selesai : 10-04-2021 19:17:10
Date of Birth/ Age 44 years 0 months 19 days Result Date
Jenis Kelamin : Laki-laki Diagnosa :-
Sex Male Diagnosis
NIK / Passport : 3276052203770010 / - Halaman :1/1
Identity No. / Passport Page
Alamat/ Ruangan :-
Address/ Clinic

Microbiology Test Result

Microbiology

PCR SARS CoV-2

Kode Label Rujukan .
Referral Code Batch
Spesimen Swab Nasofaring & Orofaring
Specimen Nasopharyngeal & Oropharyngeal Swabs
Swab ke 1
Swab Number 1
Pemeriksaan SARS-COV 2 Negatif
PCR Sars-Cov-2 Result Negative
Keterangan : Hasil tersebut hanya menggambarkan kondisi pada saat pengambilan
spesimen.
Hasil negatif belum menyingkirkan kemungkinan infeksi.
Bila timbul gejala klinis atau kontak dengan pasien terinfeksi
setelah pemeriksaan, silahkan hubungi dokter atau fasilitas
kesehatan terdekat.
pemeriksaan ulang dapat dilakukan sesuai rekomendasi dokter.
Interpretations & Advice The aforementioned result only represents the circumstances during
specimen collection.
Negative result does not always rule out your possibility of having
SARS-CoV-2 infection.
If you develop symptoms or have any form of contact with infected
patients after the test was performed, please consult your physicians
or seek medical advice in nearby healthcare facilities. Repeat tests
may be performed upon physician's request.

This is computer generated report, no signature is required. Penanggung Jawab : dr. Ardiana Kusumaningrum, SpMK
Otorisasi Oleh : dr. Ardiana Kusumaningrum, SpMK Clinical Supervisor
Authorised by Tgl Cetak : 10-04-2021 20:13:03
Printed on
RSUI Kampus UI Depok, Jl. Prof. Dr. Bahder Djohan, Pondok Cina, Beji, Kota Depok, Jawa Barat 16424 | Telephone: (021) 50829292 | https://rs.ui.ac.id