Physician dr. Hendra Koswara Address KEIP Garut JL Raya Samaranag Ganut Reg No/ Date 2012100062/ 10-12-2020 Gender Male Patient 1D 0315-2012.00102 DOB /Age 10-01-1997 /23 Year 11 Month Patient Name Mr. Ramdani Phone Address ip. Sukasirna RT. 003 VY 002 Salamnunggal Leles Garut Result status Parameter Result Ret Range Unt Note MOLECULAR SARS-CoV-2 RNA Specimen # Nasopharyngeal and Oropharyngeal ‘Swab Resut Not Detectes Not detected othod: Real-Time Reverse Teonscipon PCR (eR POR) Comment -Not Detected result indicates the absence of SARS-CoV.2 RNA In patents sample This result doscribes the Condition atthe time of specimen | callection, = Correlation with elinical condition, patiema€™s history, ‘and other diagnostic information is needed. Please contact medical doctor if any clinical indication appear, Not Detected results can be due to the presence of an inhibitor inthe patient's specimen oF the concentration ‘of vial nuciele aca ¥s below the lat of detection Specimen Collection Time: Nasopharyngeal and Oropharyngeal Swab - 10/12/20 14:36 Des boneecace1s hats /2@ ws22020 /$9ab hablar Susatle naman pitt aoa deer cope Grecaee lave Interpretation of ei) vezi shout be done only by dectomsencions Otasertnm rinieredls O@Preda Ue OEMed2d Swine saidRegNo/Date 2012100062 10-12-2020 Gender Male Patient 10 0315-2012,00102 DOB /Age 10.01.1997 /23 Year 11 Month Patient Name Mr. Ramdani Phone Parameter Resut Ref Range Unt Note Validate by Nabilah Salsabila ( Quality Validator 5 KUMI 3 Sse Teipon Nabilah Salsabiia alia q@ se-t22020 1Sa:0 gy snlh Sls emenesrsut voce a a ert cepertor Smale vive) nateatn tone og Theta nos permed nProa Cal tort, Merit Raya 150, Inteaaton oat) rent sau on Sean by onaencare OLatortorim Kink dia OGFroda tab DaProd be wanupred cold| ] Sh rodtie | SURAT KETERANGAN HASIL TES RT-PCR SARS CoV-2 RNA | (Result PCR Statement Letter) | Yang bertanda tangan di bawah ini : dr... menerangkan bahwa : nize. var, 1,The undersigned : dr. | Hereby eet Heme sete ome oviow — TAMIA Tanggal lahir (0.0.8) 7 Sarwary wot, lint Alamat (Address) TER: Suitasirng eblor, Calam Minna, ker. Lees Pekerjaan (Occupation) No.KTP es + M0 Soh os 4 Od 1CS%¥b 244 ‘Sudah dilakukan pemeriksaan (has been undertake the test of [RT-PCR SARS CoV-2 RNA dengan hasil (the resut): TERDETEKSI (DETECTED) Demikian surat keterangan ini dibuat dengan sebenar-benamya dan dipergunakan sebagaimana mestinya sesual peraturan yang berlaku. This statement letter thus made truthfully and to be used properly based on related regulation. * Lingkari/pilih yang sesuai