Republic of the Philippines

Province of Ilocos Sur

MUNICIPAL HEALTH OFFICE
Magsingal Ilocos Sur

Name: Emilia Robino Age: 75 Sex: Female

Address: San Ramon Magsingal Ilocos Sur Date of Examination: November 18,2021

SARS-COV 2 RAPID ANTIGEN TEST

KIND OF EXAMINATION

ANTIGEN TEST RESULT

Antigen Test Kit Used: LumiQuick COVID19 Antigen

Test Strip/Kit NEGATIVE
Lot No.: 20112572
Expiration Date: 2022-05
*The test result is for clinical references only and cannot be used as basis for confirming or excluding case
alone. The result is best interpreted by a physician and is not intended to be used as a sole means for diagnosis
and management. RT-PCR test is still the GOLD STANDARD for diagnosing COVID19.
***Valid for 2 weeks from the Date of Examination

MARISSA B. ARELLANO, RMT MA. NILDA RACHELLE ROMIAS, MD

Medical Technologist Municipal Health Officer
Lic. No. 0026479 Lic. No. 101622
 Republic of the Philippines
Province of Ilocos Sur
MUNICIPAL HEALTH OFFICE
Magsingal Ilocos Sur

~ MEDICAL CERTIFICATE ~
______________
DATE

To whom it may concern:

This is to certify that_______________________________________________, _____years
old child/female/male/single/married/widow from
_____________________________________________has been examined/treated/confined in this
unit undersigned on _______________________________with the
diagnosis of________________________________________________.

This CERTIFICATION is being issued upon request of

____________________________for _____________________________ purposes.

MA. NILDA RACHELLE ROMIAS, MD

Municipal Health Officer
Lic. No. 101622