BL095100921

PATIENTS PROFILE
Patients Name: Age / Sex:
CUEVAS, JENIFFER LUCIANO 31/ F

Date of birth: Nationality: Contact Number:

06/05/1990 FILIPINO 639456896563
Patients Address
URBAN DECA HOMES TONDO MANILA
Specimen Type: Laboratory accession number: Passport No:
Nasopharyngeal / Oropharyngeal COVIDID-095100921 P6472270B

REFFERING COLLECTING FACILITY/AGENCY

Name of Facility: ST.PETER-PAUL MEDICAL CLINIC, INC.

Address of Facility:

Date and time specimen collected: Date and time specimen received: Date and time results released:

01/03/2022 8:22:08am 01/03/2022 9:19:47am 01/03/2022 1:59:01pm

Specimen Number: Swab count:

1 1

INTERPRETATION OF RESULTS

Final Results: SARS-Cov-2 (Causative agent for COVID-19) viral RNA is NOT DETECTED

Interpretation: NEGATIVE for SARS-Cov-2 (Causative agent for COVID-19)

*This laboratory result should be interpreted in correlation with the available clinical and epidemiological information*

LABORATORY TEST RESULTS

Laboratory test performed: The Novel Coronavirus (2019-nCov) Nucleic Acid Diagnostic Kit PCR test is performed for the qualitative detection
of ORF-1ab, N, or E gene of SARS-COV-2. This test adopts PCR-Fluorescence Probing system technology to
detect the COVID-19 genes in real time PCR assay.

Laboratory Result: SARS-Cov-2 (causative agent for COVID-19) viral RNA is NOT DETECTED

Result units or measurements: NONE

Biological Reference intervals NONE

Performed By: Performed By:

RICHARD MARCK T. GUSTILO, RMT OLGA MAE ANN BANTOLIO, RMT

MEDICAL TECHNOLOGIST MEDICAL TECHNOLOGIST
PRC No. 0094287 PRC No. 0070784

Verified By: Noted By:

PAUL HENRY A. DURO, RMT DEXTER A. LEDESMA, MD DPSP

MEDICAL TECHNOLOGIST PATHOLOGIST
PRC No. 0091140 PRC No. 0089730

Form No. 2020-001v1

 C E R TI FI CAT I ON

Document No.: COVIDID-095100921

Date: 01/03/2022 2:02:31pm

To whom it may concern,

This is to certify that Ms. CUEVAS, JENNIFER LUCIANO, Female a/an FILIPINO national underwent COVID-19
testing using Ribonucleic Acid Reverse Transcription Polymerase Chain Reaction (RT-PCR) Test on 01/03/2022
8:20:08am at Manila Diagnostic Center for OFW Inc. an institution recognized by the Department of Health of the Philippines.

Passport number: P6472270B

Date & Time of

01/03/2022 8:20:08am
specimen collection:

Results and remarks: SARS-Cov-2 (Causative agent for COVID-19) viral RNA is NOT DETECTED

Recommendations:
o Continue COVID-19 precautionary measures.

Certification is issued upon the request of the patient for whatever purpose it may serve including travel
(Except for medico-legal purposes).

Thank you very much.

DEXTER A. LEDESMA, MD DPSP

Physician
PRC No. 0089730
BL095100921