Penanggung Jawab Laboratorium

PT. BAKTI PARAMITA PUTRASAMA Dr. George A. Mantiri, MLM (UWA), SpPK

Konsulen Patologi Klinik :

Prof. Dr. Suzanna Immanuel, SpPK (K)
Jl. Gatot Subroto Kav. 59 Jakarta 12950 DR. Dr. Tonny Loho, DMM SpPK (K)
Telp.: 5210200 (Hunting 22 Sal), Fax. :
5210184
MEDISTRA

Patient Name : SADDAM HUSEN.

DOB/SEX : 17-01-1991 / Male Ward : MCU-

ID/Nationality : 1803231701910002 / Indonesian HIS No. : CLB/20210115/00333
PID : 00-59-16-64 Lab No. : 21010289

Address : PERKANTORAN MITRA MATRAMAN, Order Date : 15-04-2022 07:25:00

JAKARTA TIMUR,
Sample Date : 15-04-2022 08:17:00
Clinician : TIM LABORATORIUM Report Date : 16-04-2022 08:20:00
Reference :

Test Name Result Reference Range Unit Method

MOLECULER

RT-PCR SARS-CoV2
Specimen Nasofaring-Orofaring
RT-PCR SARS-CoV2 Negative Negative Nucleic Acid
Test
Note:
Complete interpretation
need clinical data and
supportive data. Negative
PCR result only shows
that the pathogenic
genetic material in
question is not found in
the specimen

Note :
1. Laboratory Result interpretation only given by clinician whose have the patient data. Validated By,
2. Medistra Hospital not responsible for result not taken after 2 months.

Specimen Received Date :15-04-2022 08:17:00 Page:1/1

Printed Date: :15-04-2022 08:30, Printed by:
Results validated and verified electronically. No Signature needed.