HASIL LAPORAN TES CORONAVIRUS (COVID-19)

CORONAVIRUS (COVID-19) real time RT-PCR RESULT REPORT

Nama Pasien / Name : Reynanda Fathanza Hizrian Jenis Kelamin / Gender : Laki-laki (Male)
No. Identitas / Patient ID : 3175050106980007 Tgl. Lahir / DOB : 01/06/1998
Kebangsaan / Nationality : WNI Umur / Age : 23 Tahun

Sampling Point : Klinik Kesehatan UNPAD

Pengambilan Spesimen : 29 Mei 2021 09:41:07 Tanggal Analisis : 29 Mei 2021 13:36:09
Date of Specimen Taken Date of Analysis
Tanggal Sample Diterima : 29 Mei 2021 12:32:58 Tanggal hasil keluar : 29 Mei 2021 13:48:46
Receiving date Result date

Test Name Reagent Gen Target Ct. Value Result Test Method

RdRP -
SARS Cov-2 Biosewoom Negative Real Time RT-PCR
E Gene -

Bahwa hasil tes Coronavirus (COVID-19) adalah/That the Corona Virus (COVID-19) test result is: Negative

Jenis Spesimen / Specimen type : Naso and Oropharyngeal swab

Catatan / Note :

Hasil hanya menggambarkan kondisi saat pengambilan sampel, sesuaikan dengan klinis pasien. Pemeriksaan ulang
dapat dilakukan atas saran dokter penanggung jawab./ The result may only reflect the day when specimen was
taken, please consult to your physician for follow up examination.
Cut Off Gen Target : Positif ≤ 38, Negatif > 38

Dokter Penanggung Jawab

Doctor in charge

Larissa, dr., Sp.PK., MMRS

00013273.00000332 Clinical Pathologist Specialist

Smart Mobile Laboratory (SML-BSL2)

Jl. Dipatiukur No. 46 Bandung – Jawa Barat, Telp. 022 2512 497, 0821-1969 5900
 HASIL LAPORAN TES CORONAVIRUS (COVID-19)
CORONAVIRUS (COVID-19) real time RT-PCR RESULT REPORT
Nama Pasien / Name : Reynanda Fathanza Hizrian Jenis Kelamin / Gender : Laki-laki (Male)
No. Identitas / Patient ID : 3175050106980007 Tgl. Lahir / DOB : 01/06/1998
Kebangsaan / Nationality : WNI Umur / Age : 23 Tahun

Sampling Point : Klinik Kesehatan UNPAD

Pengambilan Spesimen : 29 Mei 2021 09:41:07 Tanggal Analisis : 29 Mei 2021 13:36:09
Date of Specimen Taken Date of Analysis
Tanggal Sample Diterima : 29 Mei 2021 12:32:58 Tanggal hasil keluar : 29 Mei 2021 13:48:46
Receiving date Result date

Test Name Reagent Gen Target Ct. Value Result Test Method

RdRP -
SARS Cov-2 Biosewoom Negative Real Time RT-PCR
E Gene -

Bahwa hasil tes Coronavirus (COVID-19) adalah/That the Corona Virus (COVID-19) test result is: Negative

Jenis Spesimen / Specimen type : Naso and Oropharyngeal swab

Catatan / Note :

Hasil hanya menggambarkan kondisi saat pengambilan sampel, sesuaikan dengan klinis pasien. Pemeriksaan ulang
dapat dilakukan atas saran dokter penanggung jawab./ The result may only reflect the day when specimen was
taken, please consult to your physician for follow up examination.
Cut Off Gen Target : Positif ≤ 38, Negatif > 38

Dokter Penanggung Jawab

Doctor in charge

Larissa, dr., Sp.PK., MMRS

00013273.00000332 Clinical Pathologist Specialist

Smart Mobile Laboratory (SML-BSL2)

Jl. Dipatiukur No. 46 Bandung – Jawa Barat, Telp. 022 2512 497, 0821-1969 5900
 HASIL LAPORAN TES CORONAVIRUS (COVID-19)
CORONAVIRUS (COVID-19) real time RT-PCR RESULT REPORT
Nama Pasien / Name : Reynanda Fathanza Hizrian Jenis Kelamin / Gender : Laki-laki (Male)
No. Identitas / Patient ID : 3175050106980007 Tgl. Lahir / DOB : 01/06/1998
Kebangsaan / Nationality : WNI Umur / Age : 23 Tahun

Sampling Point : Klinik Kesehatan UNPAD

Pengambilan Spesimen : 29 Mei 2021 09:41:07 Tanggal Analisis : 29 Mei 2021 13:36:09
Date of Specimen Taken Date of Analysis
Tanggal Sample Diterima : 29 Mei 2021 12:32:58 Tanggal hasil keluar : 29 Mei 2021 13:48:46
Receiving date Result date

Test Name Reagent Gen Target Ct. Value Result Test Method

RdRP -
SARS Cov-2 Biosewoom Negative Real Time RT-PCR
E Gene -

Bahwa hasil tes Coronavirus (COVID-19) adalah/That the Corona Virus (COVID-19) test result is: Negative

Jenis Spesimen / Specimen type : Naso and Oropharyngeal swab

Catatan / Note :

Hasil hanya menggambarkan kondisi saat pengambilan sampel, sesuaikan dengan klinis pasien. Pemeriksaan ulang
dapat dilakukan atas saran dokter penanggung jawab./ The result may only reflect the day when specimen was
taken, please consult to your physician for follow up examination.
Cut Off Gen Target : Positif ≤ 38, Negatif > 38

Dokter Penanggung Jawab

Doctor in charge

Larissa, dr., Sp.PK., MMRS

00013273.00000332 Clinical Pathologist Specialist

Smart Mobile Laboratory (SML-BSL2)

Jl. Dipatiukur No. 46 Bandung – Jawa Barat, Telp. 022 2512 497, 0821-1969 5900
 HASIL LAPORAN TES CORONAVIRUS (COVID-19)
CORONAVIRUS (COVID-19) real time RT-PCR RESULT REPORT
Nama Pasien / Name : Reynanda Fathanza Hizrian Jenis Kelamin / Gender : Laki-laki (Male)
No. Identitas / Patient ID : 3175050106980007 Tgl. Lahir / DOB : 01/06/1998
Kebangsaan / Nationality : WNI Umur / Age : 23 Tahun

Sampling Point : Klinik Kesehatan UNPAD

Pengambilan Spesimen : 29 Mei 2021 09:41:07 Tanggal Analisis : 29 Mei 2021 13:36:09
Date of Specimen Taken Date of Analysis
Tanggal Sample Diterima : 29 Mei 2021 12:32:58 Tanggal hasil keluar : 29 Mei 2021 13:48:46
Receiving date Result date

Test Name Reagent Gen Target Ct. Value Result Test Method

RdRP -
SARS Cov-2 Biosewoom Negative Real Time RT-PCR
E Gene -

Bahwa hasil tes Coronavirus (COVID-19) adalah/That the Corona Virus (COVID-19) test result is: Negative

Jenis Spesimen / Specimen type : Naso and Oropharyngeal swab

Catatan / Note :

Hasil hanya menggambarkan kondisi saat pengambilan sampel, sesuaikan dengan klinis pasien. Pemeriksaan ulang
dapat dilakukan atas saran dokter penanggung jawab./ The result may only reflect the day when specimen was
taken, please consult to your physician for follow up examination.
Cut Off Gen Target : Positif ≤ 38, Negatif > 38

Dokter Penanggung Jawab

Doctor in charge

Larissa, dr., Sp.PK., MMRS

00013273.00000332 Clinical Pathologist Specialist

Smart Mobile Laboratory (SML-BSL2)

Jl. Dipatiukur No. 46 Bandung – Jawa Barat, Telp. 022 2512 497, 0821-1969 5900
 HASIL LAPORAN TES CORONAVIRUS (COVID-19)
CORONAVIRUS (COVID-19) real time RT-PCR RESULT REPORT
Nama Pasien / Name : Reynanda Fathanza Hizrian Jenis Kelamin / Gender : Laki-laki (Male)
No. Identitas / Patient ID : 3175050106980007 Tgl. Lahir / DOB : 01/06/1998
Kebangsaan / Nationality : WNI Umur / Age : 23 Tahun

Sampling Point : Klinik Kesehatan UNPAD

Pengambilan Spesimen : 29 Mei 2021 09:41:07 Tanggal Analisis : 29 Mei 2021 13:36:09
Date of Specimen Taken Date of Analysis
Tanggal Sample Diterima : 29 Mei 2021 12:32:58 Tanggal hasil keluar : 29 Mei 2021 13:48:46
Receiving date Result date

Test Name Reagent Gen Target Ct. Value Result Test Method

RdRP -
SARS Cov-2 Biosewoom Negative Real Time RT-PCR
E Gene -

Bahwa hasil tes Coronavirus (COVID-19) adalah/That the Corona Virus (COVID-19) test result is: Negative

Jenis Spesimen / Specimen type : Naso and Oropharyngeal swab

Catatan / Note :

Hasil hanya menggambarkan kondisi saat pengambilan sampel, sesuaikan dengan klinis pasien. Pemeriksaan ulang
dapat dilakukan atas saran dokter penanggung jawab./ The result may only reflect the day when specimen was
taken, please consult to your physician for follow up examination.
Cut Off Gen Target : Positif ≤ 38, Negatif > 38

Dokter Penanggung Jawab

Doctor in charge

Larissa, dr., Sp.PK., MMRS

00013273.00000332 Clinical Pathologist Specialist

Smart Mobile Laboratory (SML-BSL2)

Jl. Dipatiukur No. 46 Bandung – Jawa Barat, Telp. 022 2512 497, 0821-1969 5900
 HASIL LAPORAN TES CORONAVIRUS (COVID-19)
CORONAVIRUS (COVID-19) real time RT-PCR RESULT REPORT
Nama Pasien / Name : Reynanda Fathanza Hizrian Jenis Kelamin / Gender : Laki-laki (Male)
No. Identitas / Patient ID : 3175050106980007 Tgl. Lahir / DOB : 01/06/1998
Kebangsaan / Nationality : WNI Umur / Age : 23 Tahun

Sampling Point : Klinik Kesehatan UNPAD

Pengambilan Spesimen : 29 Mei 2021 09:41:07 Tanggal Analisis : 29 Mei 2021 13:36:09
Date of Specimen Taken Date of Analysis
Tanggal Sample Diterima : 29 Mei 2021 12:32:58 Tanggal hasil keluar : 29 Mei 2021 13:48:46
Receiving date Result date

Test Name Reagent Gen Target Ct. Value Result Test Method

RdRP -
SARS Cov-2 Biosewoom Negative Real Time RT-PCR
E Gene -

Bahwa hasil tes Coronavirus (COVID-19) adalah/That the Corona Virus (COVID-19) test result is: Negative

Jenis Spesimen / Specimen type : Naso and Oropharyngeal swab

Catatan / Note :

Hasil hanya menggambarkan kondisi saat pengambilan sampel, sesuaikan dengan klinis pasien. Pemeriksaan ulang
dapat dilakukan atas saran dokter penanggung jawab./ The result may only reflect the day when specimen was
taken, please consult to your physician for follow up examination.
Cut Off Gen Target : Positif ≤ 38, Negatif > 38

Dokter Penanggung Jawab

Doctor in charge

Larissa, dr., Sp.PK., MMRS

00013273.00000332 Clinical Pathologist Specialist

Smart Mobile Laboratory (SML-BSL2)

Jl. Dipatiukur No. 46 Bandung – Jawa Barat, Telp. 022 2512 497, 0821-1969 5900