Jl. Raya Pajajaran No.

219
Bogor 16153
Telp. : 0251-8315456, 8370349
Fax. : 0251-8331773
Web : www.rsazra.co.id

SURAT KETERANGAN
Examination Certificate
No. 39467/RM-Lab/RS.AZRA/XII/2021

Yang bertandatangan dibawah ini, dokter Rumah Sakit Azra Bogor, menerangkan bahwa :
The undersigned, the doctor of Azra Hospital Bogor, explained that:

Nama : Muhammad Fachri Fauzi, Tn / Mr

Name

Umur : 24 Th / years old

Age

No. Rekam Medis : 287006

Medical Record Numbers

Alamat : Komplek BPT no. 5 Jl. Raya Pajajaran, BABAKAN, BOGOR

Address TENGAH, KOTA BOGOR

Adalah benar pasien Rumah Sakit Azra Bogor, yang telah dilakukan pemeriksaan Swab Antigen pada tanggal
5 Desember 2021 di Rumah Sakit Azra Bogor.
It is true that the patient of Azra Hospital in Bogor, who had taken antigen swab on 5 December 2021, at
Azra Hospital Bogor.

Laboratorium RS AZRA menyatakan bahwa hasil pemeriksaan swab antigen SARS-COV2 (RAPID) dengan
metode Immunochromatography terhadap spesimen swab antigen pasien tersebut diatas dinyatakan Negatif

AZRA Hospital Laboratory stated that the results of the SARS-COV2 (RAPID) antigen swab examination
were using the method Immunochromatography of the above patient antigen swab specimens was declared
Negative

Demikianlah surat keterangan ini dibuat agar yang berkepentingan maklum.

Thus this statement was made so that those with an interest in understanding

Bogor, 5 December 2021

Hormat Kami,
Best regards,

(dr. Tanty Herdiyani. Sp. PK)

Dokter Pemeriksa
Examining Doctor