SURAT KETERANGAN

MEDICAL CERTIFICATE

Nama (Name) : Agus Fachrur Rozy ID Sampel (Sample ID) : 389558/E/ATG/OMSAMEDIC/KLN/IV/2022

NIK (ID) : 5171021408920001 Sampel (Sample) : Nasofaring
Tanggal Lahir (D.O.B) : 14 Agustus 1992 Tanggal Pemeriksaan (Testing Date) : 29 April 2022 (April 29th, 2022)
Jenis Kelamin (Sex) : Laki-Laki (Male) Waktu Pemeriksaan (Testing Time) : 10:09:34 WITA
Alamat (Adress) : Jl. Letdareta GG. XXVI No.9 Lokasi Pemeriksaan (Testing Location) : Klinik Omsa Medic
No Telp (Phone No) : 087738963942 Dokter Pemeriksa (Attending Phsycian) : dr. Romy Kamaludin, S.Ked., Biomed (AAM)

Jenis Pemeriksaan Hasil Nilai Rujukan

(Test) (Result) (Reference Value)

SARS-CoV-2 Antigen Negatif (Negative) Negatif (Negative)

Interpretasi : Negatif
Interpretation : Negative

Catatan (Note) :
1. Hasil negatif tidak menyingkirkan kemungkinan terinfeksi SARS-CoV-2 sehingga masih beresiko menularkan ke orang lain
Negative results do not rule out the possibility of being infected with SARS-CoV-2 so there is still a risk of transmitting it to other people.
2. Hasil negatif dapat terjadi pada kondisi kuantitas antigen pada specimen dibawah level deteksi alat.
Negative results can occur when the antigen quantity in the specimen is below the device detection level.

Tanggal : Situbondo, 29 April 2022

Date : Situbondo, April 29th, 2022

Pemeriksa
Checker

(dr. Romy Kamaludin, S.Ked., Biomed (AAM))

Klinik Omsa Medic

NB:
1. Kementrian Kesehatan Republik Indonesia. 2020. Pedoman Pencegahan dan Pengendalian Coronavirus Disease (COVID-19), revisi 05.
Ministry of Health of the Republic of Indonesia. 2020. Guidelines for the Prevention and Control of Coronavirus Disease (COVID-19), revision 05.

2. Panduan Tatalaksana Pemeriksaan Antigen Rapid Test SARS-CoV-2 Perhimpunan Dokter Spesialis Patologi Klinik dan Kedokteran Laboratorium Indonesia (PDS PatKlin).
Guidelines for the Management of the SARS-CoV-2 Antigen Rapid Test for the Association of Indonesian Clinical Pathology and Laboratory Medicine Specialists (PDS PatKlin).

Phone (0361) 4747 651. Call Center 0818311354. E-mail info@omsamedic.com. Website
www.omsamedic.com