PATIENT IDENTITY REFFERAL PHYSICIAN

MRN : C.6710.2257.3910 PN010 Name : dr.Wahyu Iman santoso, Sp. PK

Register No. : HSL-631472-6637 Swab Date : 08/01/2023 08:02:44
Name : ATIKAH Order Date : 08/01/2023 08:19:51
ID Card : E1806013 Result Date : 08/01/2023 15:30:45
DOB : 05/05/1997 (25 Year) FEMALE Source Name : LABORATORY
Address : DSN GARUT JAWA BARAT Room : -

LABORATORY
Examination Result Unit Reference Value Information

BIOMOLECULAR (PCR)
PCR Covid 19 Negative ( Swab : 1 )
CT Value Not Detected
Note :
Result Interpretation :
Positive : Positive SARS Cov - 2
CT Value < 36
Negative : Negative SARS Cov - 2
CT Value > 36

CT Value Interpretation :
30 - 36 : Virus gen detected in small amount and low contagious.
<30 : Virus gen detected in high amount and highly contagious

Tim verifikator klinis : Result Release

- dr. Meiti Muljanti, Sp. PK Surabaya, January 3, 2023
- Prof. Dr. Jusak Nugraha dr., MS., Sp. PK(K)
- Assoc. Prof. Rahajoe Imam Santosa, dr. Sp. PK(K)
Laboratory officer
Printed By : Aisyah
FRM/LAB/H-1710/066
Printed Date : (08/01/2023 15:30:45)
*If printed then no signature is required
Rev.00

*Notice :
* Modifying the content of this report is againist the law.

NATIONAL HOSPITAL Jl.Boulevard Famili Selatan Kav. 1 Graha Famili Surabaya 60228
Jawa Timur - Indonesia P031.2975 777 F031.2975799
www.national-hospital.com