COVID-19 TEST REPORT

Patient Information Specimen Information

- Medical Report Number : 2106141000177996 - Facility Name : AHC - Husein Sastranegara International Airport (BDO)
- Full Name : DWI WAHYUDI - Test Name : SARS-CoV-2/2019-nCoV
- Nationality : Indonesia - Sample Type : Nasopharyngeal swabs
- Date of Birth : 12-03-1984 - Date Collected : 26-04-2022 06:18:46 (WIB)
- Gender : Male - Field Technician ID : BDO017
- ID/Passport Number : 3204381203840004 - Field Analyst ID : BDO036
- Phone Number : 081321678950
- Email Address : dwiwah1203@gmail.com

Test Result Summary

- Test Method : SARS CoV-2/2019-nCov
Antigen Rapid Diagnostic Test

Result Validation Check By

SARS-CoV-2/2019-nCoV
dr. Ursula Nauli Malau, Sp.PK
NEGATIVE (Medical Consultant)

Maulina Nur Azizah, A.Md.AK

(Field Analyst)

Processing and Detection Methodology

The antigen rapid diagnostic test (Ag-RDT) directly detects viral proteins or antigen of SARS-CoV-2, the virus that causes COVID-19, in respiratory samples using a method of lateral
flow immunoassay.
Disclaimer
The information contained in this report is intended to be interpreted by licensed physician or other licensed healthcare professional. This report is not intended to take the place of
professional medical advice. Decisions regarding course of medical treatment must be made only after consulting with a licensed physician or other licensed healthcare professional,
and should consider each patient's medical history.

This test was performed by FARMALAB, is a laboratory brand owned by PT Farmalab Indoutama, Jalan HR. Rasuna Said X-5, 16th Floor, Jakarta 12950 - Indonesia, a company
engaged in Laboratory Testing Services and Health Service Activities by paramedics, has a recommendation for a Covid-19 examination laboratory from the Ministry of Health of the
Republic of Indonesia. // Please email to the following address: customer.care@farmalab.id, or call by phone number 02186617112 to contact customer service or get more
information.

This document is signed electronically using an electronic certificate provided by the Agency for the Assessment and Application of Technology in accordance with Law Number 11 of
2008 concerning Electronic Information and Transactions, electronic signatures have legal force and legal consequences.