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Reg..No. 2L06t9027s Age : 19 Year 7 Month 5 Day
Reg. Date 19-06-2021 Patient ID :2021029737
Name MAJABELLE, LAWAC Company : PASIEN UMUM
Gender / DOB Female I t4-Lt-200t Doctor : RS BHAKTI MHAYU

Address RS BAKTI MHAYU / GMND HYATT Received Specimen :1910O12021 18:22:36

BALI ROOM 1131

PEMERIKSAAN HASIL NILAI RU]UKAN METODE

TEST RESULT REFERENCE RANGE METHOD

SARS.CoV-2
Gen ORF lab Negatif Negatif RT-iiPCR
Negative Negative

Catatan
Note

-Hasil Negatif menunjukkan tidak terdeteksi RNA virus SARS-CoV-2 dalam spesimen
x Negative resutts indicate no detectable SARS -CDV -2 RNA virus in the specimen

Waktu Pengambilan Spesimen :

Specimen Collcetion Date

Swab NP/OP :19-06-2021 18:22

Kepala Laboratorium : dr. I.A. Putri Wirawati, SpPK (K)

(Head ofLaboratory)
Konsultan : Dr. dr."Ida Sri Iswari, SP.M( M.Kes
(Consultant)
<> : Implementasi ISO 15189
Denpasar, t910612021
Analis Diautorisasi oleh
Analyst

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Reg. No. 2106t90274 Age 43 Year 1 Month 27 Day

Reg. Date 19-06-2021 Patient ID 202t029739

Name FEDERICA, TONON Company PASIEN UMUM

Gender / DOB Female 122-04-L978 Doctor RS BHAKTI MHAYU

Address RS BAKTI MHAYU / GMND HYATT Received Specimen 1gt}6l2}21 18:22:42

BAU ROOM 1131

PEMERIKSAAN HASIL NILAI RUJUKAN METODE

T6T RESULT REFERENCERANGE METHOD

SARS-CoV-2
Gen ORF 1ab Negatif Negatif RT-iiPCR
Negative Negative

Catatan
Note

- Hasil Negatif menunjukkan tidak terdeteksi RNA virus SARS-CoV-2 dalam spesimen
x Negative results indicate no detectable SARS -CoV -2 RNA virus in the specimen

Waktu Pengambilan Spesimen :

Specimen Collcetion Date

Swab NP/OP '. 19-06-2021 18:22

Kepala Laboratorium : dr. I.A. Putri Wirawati, SpPK (K)

(Head oflaboratory)
Konsultan : Dr. dr..Ida Sri Iswari, Sp.M( M.Kes
(Consultant)
<> : Implementasi ISO 15189
Denpasar, Lgl06l202l
Analis
Analyst

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Age 24Year3Month8DaY
Reg. No. 2t06190275
Patient ID 2021029743
Reg. Date 19-06-2021
Company PASiEN UMUM
Name JOE, LOTI
Doctor RS BHAKTI MHAYU
Gender / DOB Female / 11-03-1997
Received SPecimen 1910612021 18:22:47
Address RS BAKTI MHAYU / GMND HYATT
BALI ROOM 1131

NILAI RUJUKAN METODE

PEMERIKSAAN HASIL METHOD
RESULT REFERENCERANGE
TEST

SARS-COV-2
Gen ORF lab

Catatan
Note

- Hasil Negatif menunjukkan tidak terdeteksi RNA virus sARS-CoV-2 dalam spesimen
; i;;;i;z-;;r;ii iiioi" no detectabte sARS -d/ -2 RNA virus in the specimen

Waktu Pengambilan SPesimen :

Specimen Collcetion Date

Swab NP/OP :19-06-2021 18:22

Kepala Laboratorium : dr' I.A. Putri Wirawati, SpPK (K)

(Headoflaboratory) .

Konsultan : Dr.dr. Ida Sri Iswari, SP.MK, M.Kes

(Consultant)
<> : Implementasi ISO 15189 Denpasar, L910612021
Analis Diautorisasi oleh
AnalYst
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Reg. No. 2106190273 Age 23Year 10 Month 9 Day
Reg. Date 19-06-2021 Patient ID 2021029733

Name SHERYSYN, TOKO Company PASIEN UMUM

Gender / DOB Female / 10-08-1997 Doctor RS BHAKTI MHAYU

Address RS BAKTI MHAYU / GMND HYATT Received Specimen 1910612021 18:22'54

BALI ROOM 1131

PEMERIKSAAN HASIL NILAI RUJUKAN METODE

TET RESULT REFERENCERANGE METHOD

SARS-CoV-2
Gen ORF 1ab Negatif Negatif RT-iiPCR
Negative Negative

Catatan
Note

- Hasil Negatif menunjukkan tidak terdeteksi RNA virus SARS-CoV-2 dalam spesimen
x Negative results indicate no detectable SARS -A/ -2 RNA virus in the specimen

Waktu Pengambilan Spesimen :

Specimen Collcetion Date

Swab NP/OP :19-06-2021 18:22

Kepala Laboratorium : dr. LA, Putri Wirawati, SpPK (K)

(Head ofLaboratory)
Konsultan : Dr. drr Ida.Sri Iswari, Sp.MK, M.Kes
(Consultant)
<> : Implementasi ISO 15189
Denpasar, 1910612021
Analis
Analyst
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Reg. No. 2106t90278 Age 18 Year 1 Month 7 Day

Reg. Date L9-06-202t Patient ID 2021029740

Name CHANTALE LEOW, WILLIE Company PASIEN UMUM

Gender / DOB Female I t2-05-2003 Doctor RS BHAKTI MHAYU

Address RS BAKTI RAHAYU / GMND HYATT Received Specimen 1910612021 18:23:00

BALI ROOM 1131

PEMERIKSAAN HASIL NILAI RUJUKAN METODE

TET RESULT REFERENCERANGE METHOD

SARS-CoV-2
Gen ORF 1ab Negatif Negatif RT-iiPCR
Negative Negative

Catatan
Note

-Hasil Negatif menunjukkan tidak terdeteksi RNA virus SARS-CoV-2 dalam spesimen
x Negative results indiate no detectable SARS -CoV -2 RNA virus in the specimen

Waktu Pengambilan Spesimen :

Specimen Collcetion Date

Swab NP/OP :19-06-2021 18:23

Kepala Laboratorium : dr. LA. Putri Wirawati, SpPK (K)

(Head oflaboratory)
Konsultan : Dr. dr Ida Sri Iswari, Sp.MK, M.Kes
(@nsulbnt)
<> : Implementasi ISO 15189
Denpasar, L910612021
Analis oleh
AnalYn
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Age 44Year 6 Month 26 DaY
Reg. No. 2106t90270
Patient ID 2021029735
Reg. Date 19-06-2021
Company PASIEN UMUM
Name DEBBIE LYN, WOOSTER
Doctor CHECK UP INSTANSI
Gender / DOB Female 123-t7-t976
Received SPecimen 1910612021 18:23:05
Address RS BAKTI MHAYU / GMND HYATT
BALI ROOM 1131

NILAI RUJUKAN METODE

PEMERIKSMN HASIL
REFERENCE RANGE METHOD
TEST RESULT

Catatan

- Hasil Negatif menunjukkan tidak terdeteksi RNA virus SARS-CoV-2 dalam spesimen
i iiiuiie-iitrtx iniicite no detectabte SARS -CoV -2 RNA virus in the specimen

Waktu Pengambilan SPesimen :

Specimen Collcetion Date

Swab NP/OP .:19-06-2021 18:23

(K)
Kepala Laboratorium : dr. I.A. Putri Wirawati, SpPK
(Head oflaboratory)
Konsultan : Dr. dr. Ida Sri Iswari, SP.MK, M.Kes
(Consulbnt)
<> ; Implementation of ISO 15189 Denpasar, 1910612021
oleh
Analis
Analyi

5wari, Sp.MK, M.Kes

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lltffi llllllill lllll lllllllllllllil lllillllll lllllllllllll
Age 33 Year 8 DaY
Reg. No. :2L06L90277
Patient ID 202L029742
Reg. Date : 19-06-2021
PASIEN UMUM
Name : PATA, MILLER Company
Doctor RS BHAKTI MHAYU
Gender / DOB : Female / 11-06-1988
Received SPecimen 1910612021 18'.23:13
Address : RS BAKTI MHAYU / GMND HYATT
BALI ROOM 1131

NILAI RUJUKAN METODE

PEMERIKSMN HASIL METHOD
RESULT REFERETICE RANGE
TEST

SARS-CoV-2
Gen ORF 1ab

Catatan
Note

- Hasil Negatif menunjukkan tidak terdeteksi virus sARS-CoV-2 dalam spesimen

RNA
i iiiuiiZ-iituttt indicite no detectable SARS-bV-2 RNA virus in the specimen

Waktu Pengambilan Spesimen :

Specimen Collcetion Date

Swab NP/OP '. 19-06-2021 18:23

(K)
Kepala Laboratorium : dr. I.A. Putri Wirawati, SpPK
(Head ofLaboratory)
Konsultan : Dr. di Ida Sri Iswari, Sp'MK, M'Kes
(@nsulbnt)
<> : Implementasi ISO 15189 Denpasar, tgl06l202t

\
Analis
Analyst

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Reg. No. 2106190280 Age 56 Year 8 Month 22Day

Reg. Date 19-06-2021 Patient ID 202t029736

Name STEVEN AUGUSTUS, ANDERSON Company PASIEN UMUM

Gender / DOB Male 127-09-1964 Doctor RS BHAKTI MHAYU

Address RS BAKTI MHAYU / GMND HYATT Received Specimen 1910612021 18:22:22

BALI ROOM 1131

PEMERIKSAAN HASIL NILAI RUJUKAN METODE

TET RESULT REFERENCERANGE METHOD

SARS-CoV-2
Gen ORF 1ab Negatif Negatif RT.iiPCR
Negative Negative

Catatan
Note

- Hasil Negatif menunjukkan tidak terdeteksi RNA virus SARS-CoV-2 dalam spesimen
* Negative results indicate no detectable SARS -@/ -2 RNA virus in the specimen

Waktu Pengambilan Spesimen :

Specimen Collcetion Date

Swab NP/OP :19-06-2021 18:22

Kepala Laboratorium : dr. LA. Putri Wirawati, SpPK (K)

(Head ofLaboratory)
Konsultan : Dr.,dr. Ida Sri Iswari Sp.MK, M.Kes
(Consu/tant)
<> : Implementasi ISO 15189
Denpasar, 191061202t
Analis
Analyst

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