Dos. No. WIG FOR TSS 05-007-02 FORM Effective Date; 28 JUL 2020 Revision No. : 02 SERVICE REPORT Bonet iia tr ten 10012 TM CustomerName BS" Bunon Jabnets Calls Statistos Labor (time) : Ol Is~ Hours Address: Ji. Tee Clk Ditieo No 20 Travel (time): @-5~ _ Hours ‘Travel (days) : NA Days MeN Tene D4 eRe TA a TSS arrival on site Contact Person AND) Date 2 BO Mae te Time IS Phone No. OVI) Fb SOY Ee Instrument retumed for service System 6K Date 30 mae eel Time Serial No. :_ G8 tos Type of Service* —_: [1] Installation ©] Repair 1 Preventive Maintenance C1 Customer Visit Customer Reported _ Hod, | Eneen, Work Have Been Done : Sa CBOW Nhe: brpmiirarty > beelice Munes 1 sé 0co P89 172 SIN New PUSS19 Main Tenses — ColLE ct 1m Letoey eno ED eNOS Remark Acat DAQAT Di Genakan OENCHn BAIL Part # Description Quantity | _ Price/ Unit Total 900 - cyt Meore sai 2essrg ot Na N/A ih Ni ni | WA N/A Ni Wi a | Aik WA [Medquest’s Technical Support Service Printed Name :_T@S~/ Signature : ae Date: ZO Man 24 *) Give a mark (\) in appropriate square [PT Medquest Jaya Global ‘Menara Salemba 6th Fl Zone 1, J. Salemba Raya No. § - A, Jakarta Pusat 10440 - Indonesia ‘Telp: +6221 3984 2061, Fax: +6221 3193 7736832208-RSU Bunda Jakarta-Jakarta-ndonesia 30/03/21 11:16:00 GeneXpert® Dx System Installation Qualification Report This report provides documented evidence of the installation of this GeneXpert® Dx System, System Information GeneXpert® Dx System Pass Java Runtime Environment 1.8. Pass GX Utils. DLL. Pass SQL Database Microsoft SQL Server 13.00.4001 Pass Database ox db 3.0.9.0 Pass Operating System ‘Windows 10 10.0, Pass CIT Plug-in 1 Pass Instrument Information Instrument B Bt 758172 <7 CLD Pass 82 781058 3.3.3 Pass Shaded Modules = Reporter is out of calibration, Available Assays Sen Xpert BCR-ABL Monitor IS G2 fl In Vitro Diagnostic Xpert CT_NG 3 In Vitro Diagnostic Xpert HBV Viral Load 1 In Vitro Diagnostic Xpert HCV VL Fingerstick 1 In Vitro Diagnostic Xpert HIV-1 Qual 1 In Vitro Diagnostic, Xpert HIV-1 Viral Load 4 In Vitro Diagnostic, Xpert HPV 16 18-45 1 In Vitro Diagnostic Xpert MRSA-SA SSTI G3 5 In Vitro Diagnostic Xpert MTB-RIF Assay G4 6 In Vitro Diagnostic pert Xpress SARS-CoV-2 2 In Vitro Diagnostic Genexpert® Dx System Version 5.1 Page 1 of 2832203-RSU Bunda Jakarta-Jakarta-Indonesia 30/03/21 11:16:00 GeneXpert® Dx System Installation Qualification Report Xpert_HCV Viral Load In Vitro Diagnostic Installation of networked instruments complies with the setup requirements specified in the GeneXpert® Dx System Operator Manual, ‘installation’ section. Verified by Date This 1Q is acceptable if all System Information and Instrument Information are listed as ‘Pass’. All instrument ‘modules that are listed as ‘Pass’ are available for use. Acceptance: [ Acceptable [ ] Not Acceptable Performed by Date Reviewed and approved by Date Page 2 of 2 GeneXpert® Dx System Versi832203-RSU Bunda Jakarta-Jakarta-Indonesia 30103721 12:20:53, GeneXpert® Dx System Installation Qualification Report This report provides documented evidence of the installation of this GeneXpert® Dx System. Sate formation GeneXpert® Dx System 5. Pass Java Runtime Environment Pass GX _Utils.OLL Pass SQL Database Microsoft SQL Server 13.00.4001 Pass. Database x db 3.0.9.0 Pass Operating System ‘Windows 10 10.0 Pass CIT Plug-In 1 Pass Instrument Information Instrument B in 832203 2.0.18 Bt 725519-PNe, 3.3.8 23.2 Pass. B2 781058 33.3 236 Pass ‘Shaded Modules = Reporteris out of calibration. Available Assays Xpert BCR-ABL Monitor IS G2 1 In Vitro Diagnostic Xpert CT_NG 3 In Vitro Diagnostic Xpert HBV Viral Load 1 In Vitro Diagnostic. Xpert HCV VL Fingerstick 1 In Vitro Diagnostic Xpert HIV-4 Qual 1 In Vitro Diagnostic Xpert HIV-1 Viral Load 1 In Vitro Diagnostic, Xpert HPV 1618-45 1 In Vitro Diagnostic Xpert MRSA-SA SSTI G3 5 In Vitro Diagnostic Xpert MTE-RIF Assay G4 6 In Vitro Diagnostic, Xpert Xpress SARS-CoV-2 2 In Vitro Diagnostic GeneXpen® Dx System Version 5.1 Page 1 of 2832203-RSU Bunda Jakarta-Jakarta-Indonesia 30/03/21 12:20:53, GeneXpert® Dx System Installation Qualification Report = me Xpert_HCV Viral Load In Vitro Diagnostic Installation of networked instruments complies with the setup requirements specified in the GeneXpert® Dx System Operator Manual, Installation’ section. Verified by Date This IQ is acceptable if all System Information and Instrument Information are listed as ‘Pass’. All instrument ‘modules that are listed as ‘Pass’ are available for use. Acceptance: [ J Acceptable [J Not Acceptable Performed by Date Reviewed and approved by Date GeneXpert® Dx System Version 5.1 Page 2 of 2