LABORATORY REPORT

CONSULTANT : dr. Sri Ratna Dewi,M.Sc.,Sp.PK Lab. No : 1022037651

Page : 1 of 1 PRN : 00065739

Doctor : INAYAH LUKMAN ALGADRIE, Name : AGUS SETIAWAN
GENERAL PRACTITIONER Date of Birth : 14-08-1981 (41Y) / Male
Started : 26-11-2022 17:10:00
: 26-11-2022 17:15:00 Ward : UGD
Finished
Printed : 26-11-2022 17:15 Address : JL. TUNJUNG SARI

TEST REQUIRED RESULT UNITS REFERENCE RANGE

IMMUNOLOGY

Antigen SARS-CoV-2 Negative Negative

Note :
1. Positive antigen result should be confirmed by PCR Method
2. Negative results can be found in :
- Not infection of COVID -19
- Low consentration of Antigen
Negative results with Covid-19 sign & symptoms or close contact person must be confirmed
by genotype method (PCR)
* (Sample : Nasopharyngeal Swab)

H : High Result L : Low Result HH : High Critical Value LL : Low Critical Value

Jl. Teuku Umar 120, Denpasar Checked by: Ni Made Yoanda Andyuani, A.Md.AK
80114
Bali - Indonesia
Telp. : (0361) 300 3030
Fax. : (0361) 238 690
E-mail : care@kih.co.id
www.kih.co.id Scan QRCode to Validate *This is a computer generated report, No signature is required.