CITY OF DASMARIÑAS MOLECULAR DIAGNOSTIC

LABORATORY
Brgy. Langkaan II, sitio Humayao City of Dasmariñas, Cavite
Email: molecularlab.pd@gmail.com

COVID-19 RT-PCR LABORATORY RESULT FORM

Name of Patient: FUJIBAYASHI, ALISA LLESIS Patient Location::

(Last name, First name, Middle name) [ ] OPD [ ] REFERRAL [ ] INPATIENT
Age/Gender 20 Y / FEMALE Date of Birth: 06/22/2002 Nationality: FILIPINO
(MM/DD/YYYY)
Civil Status: SINGLE Complete Address: BLK 3 LT 10 PHASE D, TREELANE 2, CITY OF IMUS, BAYAN LUMA III, CAVITE,
REGION IV-A (CALABARZON)
Contact No.: +639455495517 Email Address: saliafuji@gmail.com Accession No.: CDMDL-22-024227

Specimen Type: NPS/OPS Disease Reporting Unit: PAGAMUTAN NG DASMARIÑAS Laboratory No.:

Date and time of specimen collection Date and time of Specimen Receipt:
(MM/DD/YYYY HH:MM) (MM/DD/YYYY HH:MM)
10/11/2022 11:53 AM 10/11/2022 2:44 PM
Date and Time of Release of Result:
(MM/DD/YYYY HH:MM)
10/11/2022 9:33 PM

LABORATORY TEST RESULT

SARS-CoV-2 (causative agent of COVID-19) virus detection by Real-Time Polymerase Chain
LABORATORY TEST PERFORMED:
Reaction
TEST RESULT: SARS-CoV-2 (causative agent of COVID-19) viral RNA not detected

INTERPRETATION OF RESULTS:

FINAL RESULT INTERPRETATION

SARS-CoV-2 (causative agent of COVID-19) viral RNA
Positive for SARS-CoV-2 (causative agent of Covid-19)
detected
SARS-CoV-2 (causative agent of COVID-19) viral RNA not
Negative for SARS-CoV-2 (causative agent of Covid-19)
detected
Invalid due to specimen quality Negative for test internal control (due to poor specimen quality)

*This laboratory result should be interpreted by a qualified physician with the available clinical and epidemiological information.

Comments:

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Performed By: Verified By: Validated & Approved By:

EMY G. TABANG RMT FLORECITA LUDIVINA T. SOLIS MD,

Medical Technologist FPSP
License No: 0049436 License No: 0080537
JARED IMMANUELLE P. ALMONTE
RMT
Quality Assurance Officer
License No: 0088506 MA. TERESA A. BARZAGA MD, FPSP
JUDITH B. SIBULANGCAL RMT License No: 0053188
Medical Technologist
License No: 0089402 Pathologists

THIS IS A COMPUTER GENERATED REPORT. Doc control #: CDMDL-SOP-FM-01