BL0951007

PATIENTS PROFILE
Patients Name: Age / Sex:
JUMRATAN, RADZMA JAMILUL 33 / F

Date of birth: Nationality: Contact Number:

06/04/1988 FILIPINO 639306079001
Patients Address
TUBURAN BASILAN ZAMBOANGA CITY MINDANAO (PROVINCE)
Specimen Type: Laboratory accession number: Passport No:
Nasopharyngeal / Oropharyngeal COVIDID-0951007 P7178850B

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:

12/30/2021 8:20:08am 12/30/2021 9:17:47am 12/30/2021 1:55:01pm

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

 CERT IFICAT ION

Document No.: COVIDID-0951007

Date: 12/30/2021 2:02:31pm

To whom it may concern,

This is to certify that Ms. JUMRATAN, RADZMA JAMILUL , Female a/an FILIPINO national underwent COVID-
19 testing using Ribonucleic Acid Reverse Transcription Polymerase Chain Reaction (RT-PCR) Test on 12/30/2021
8:20:08am at Manila DIagnostic Center for OFW Inc. an institution recognized by the Department of Health of the Philippines.

Passport number: P7178850B

Date & Time of

12/30/2021 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
BL0951007