Komplek Citra Indah Blok A6 No.

1
Batam, Kepulauan Riau
Telp: (0778) 468388
E-mail : Labplus.batam@gmail.com

HASIL TEST SWAB FASTLAB REALTIME PCR COVID-19

Test Results Swab Fastlab Realtime PCR Covid-19
No:17/PCR/LABPLUS/VI/2022

Truly certify that / Menerangkan dengan sesungguhnya dibawah ini:

Id Lab/Nomor Lab C.896.7674 Adreess/Alamat Domisili Hotel Hallo Batam

Id Card/Nomor
3328101408970004 No. Handphone/No. Hp 085225443545
Ktp/Paspor

Date Of Sampling/
Name/Nama Tomi Sugiarto Tanggal Pengambilan 4 June 2022
Sampel

Date Of Examination/
Sex/Jenis Kelamin Laki - Laki 4 June 2022
Tanggal Pemeriksaan

Date Of Birth/Tanggal Date Of Result/ Tanggal

14 Agustus 1997 4 June 2022
Lahir Pengeluaran Hasil

Swab Nasofaring (Hidung)

Specimen/Spesimen
Orofaring (Tenggorokan)

Real Time PCR SARS-CoV-2 has been carried out, Results/ Telah dilakukan Real Time PCR SARS-CoV-2, Hasil:

NEGATIVE/NEGATIF
CT Value ORF : N/A CT Value N Gene : N/A
Cut off value : ≤ 38 Cut off value : ≤ 38

The Result above describe it current condition of the specials were taken. When clinical symptoms occur
or contact with an infected patient after an examination, please contact the nearest health facility.
According to the doctor’s recommendation, then it can be re-examination.
Hasil di atas hanya menggambarkan kondisi saat spesimen diambil. Bila timbul gejala klinis atau kontak
dengan pasien terinfeksi setelah pemeriksaan, silahkan menghubungi fasilitas Kesehatan terdekat.
Berdasarakan rekomendasi Dokter, maka pemeriksaan dapat dilakukan.

Batam,
Klinik LabPlus, HASIL SWAB RT-PCR(Nama :Tomi Sugiarto, Tanggal Lahir :14 4 June
Agustus 1997,2022
ID Lab :C.896.7674, Status :NEG
Mengetahui/Acknowledge,

dr. Amat

*Anyone who deliberately falsifies medical record evidence, will be subject to punishment in accordance with Article 263 paragraph 1 of the
Criminal Code (KUHP)
*Barangsiapa dengan sengaja memalsukan bukti rekam medis, akan dikenakan hukuman sesuai dengan Pasal 263 ayat 1 KUHP.