LABORATORY RESULTS

Name: Mobile Phone: Gender: Collection Time (local): Order Number: Requesting Provider:
Fernando Ezequiel Roldan (202) 487-9256 MALE 09:28 am 0000329531 KARI ROLLINS, DO

SP E C IM E N

P ROV ID E R
Birthday: Age: Collection Date (local): Report Status: SAMEDAY TESTING
PATIE N T

12/26/1976 43 12/15/2020 FINAL 10401 Old Georgetown Rd

Bethesda, MD 20814
Received Date: Report Date:
12/15/2020 12/15/2020

COVID-19 PCR

COVID-19 PCR Result Flag Reference Range

SARS-CoV-2 (COVID-19) by RT-PCR 1 Not Detected Not Detected

The COVID-19 Real-Time RT-PCR test is a lab-developed test (LDT) based on Applied Biosystems TaqMan 2019-nCov assays targeting three CoV-2 genes (ORF1ab, S Gene/Protein, and N Gene/Protein) and one
positive control assay. This test has been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses or pathogens. This test was developed and its performance characteristics
determined by Signal Diagnostics. This test has not been FDA cleared or approved. This test has been authorized by the FDA under an Emergency Use Authorization (EUA). This test has been validated in accordance
with the FDA's Guidance Document (Policy for Diagnostics Testing in Laboratories Certified to Perform High Complexity Testing under CLIA prior to Emergency Use Authorization for Coronavirus Disease-2019
during the Public Health Emergency) issued on February 29th, 2020. FDA independent review of this validation is pending. This test is only authorized for the duration of time the declaration that circumstances
exist justifying the authorization of the emergency use of in vitro diagnostic tests for detection of SARS-CoV-2 virus and/or diagnosis of COVID-19 infection under section 564(b)(1) of the Act, 21 U.S.C. 360bbb-
3(b)(1) unless the authorization is terminated or revoked sooner.
For Patients: https://app.flowhealthlabs.com/fda/RT-PCR_Patients.pdf
For Providers: https://app.flowhealthlabs.com/fda/RT-PCR_Providers.pdf

PERFORMING LABORATORIES
1 UNITED MEDICAL LABORATORIES, INC. Lab Director: GEORGE CHANG CLIA: 49D0222887

8885 Venice Blvd Los Angeles, CA 90034 Phone: (323) 905-0125 cs@flowhealth.com Page 1 of 1