Republic of the Philippines

Department of Health
SAN LAZARO HOSPITAL
Subnational Reference Laboratory
Manila, Philippines
Telephone Nos.: 8732-3776 to 78; 8732-3106
E-mail Address: sanlazarohospital@yahoo.com Official Website: www.slh.doh.gov.ph

SUMMARY LIST OF SPECIMENS REFFERED FOR COVID 19 TESTING

Disease Reporting Unit Date of Specimen Shipment:

MAKATI HEALTH DEPARTMENT 07/16/2020
(Hospital/Agency): (mm-dd-yyyy)
Time of Specimen Shipment:
Region: NCR Province: METRO MANILA
(hh:mm)
Contact Person: SONNY PERALTA, RN Courier/Agency Vehicle: MAKATI HEALTH DEPARTMENT
Telephone Number/Mobile Number: 88701446/ 09178446739 Official E-mail address: makaticesuresults@gmail.com

SLH Hospital No. Date of Specimen Time of Specimen Remarks (indicate if

Lab. No. Name of Patient Date of Birth Age Sex
(SLH use Collection Collection 1st or 2nd)
(SLH use only)
only) (Surname, First Name, Middle Name) (mm/dd/yyyy) (years-months) (M/F) (mm/dd/yyyy) (hh/mm) AM/PM
1. CAM, MANILA VOSOTROS 05/19/1984 36 F 07/16/2020 4:00PM 1ST
2. CAPADA, ASHANTI CAM 10/13/2014 5F 07/16/2020 4:02PM 1ST
3. SENESIO, KENETH POQUIZ 09/18/1987 32 M 07/16/2020 4:04PM 1ST
4. CAM, MICHELLE VOSOTROS 3/6/1987 33 F 07/16/2020 4:06PM 1ST
5. DIEZ, MA. CARMIELA N/A 4/3/2007 13 F 07/16/2020 4:08PM 1ST
6. CAM, SOPHIA HELLEY VOSOTROS 12/30/2005 14 F 07/16/2020 4:10PM 1ST
7
8
9
10
11
12
13
14
15
16
17
18
19
20
E-mail Address: slhlab.covid19@yahoo.com SLH- SNL COVID Specimen Summary List Form 2020

Total No. of Specimens Submitted: 6 SPECIMENS Submitted by: ARMAN FABI, RN Received by:
(Hospital Facility Staff) (SLH- SNL Staff)