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TZU CHI HOSPITAL

Tzu Chi Center, Jl. Pantai Indah Kapuk Boulevard, Jakarta Utara 14470
Call Center : 021 5095 0888 | IGD : 021 5095 0800 | www.tzuchihospital.co.id

LABORATORY REPORT
Patient Name Agus Tisar Sentosa Episode No. O0000199572
No. MR 0000079028 Lab Registration No. 231920143
Sex Laki-Laki Order Time 11/07/2023 15:08
DOB 26 Aug 1995 Collected 11/07/2023 16:48
Location Drive Thru Test Received 11/07/2023 16:48
Orderred By Santoso Kurniawan, Dr. MM Printed 11/07/2023 16:51

Consultant Clinical Pathologist Prof.Dr. Suzanna Immanuel, Sp.PK(K)


Clinical Pathologist Dr. Ricky Tjahjadi, Sp.PK
Dr. Siskawati Suparmin, Sp.PK

Immunoserology

Test Result Flag Ref. Range


SARS-COV2 Antigen (Rapid) Non-Reactive Normal: Non-Reactive

Laboratory result should be discussed with the sending doctor Authorized By Yuna Ningsih, A.Md.AK

The laboratory result has been verified electronically, no signature is required Authorized Date/Time 11/07/2023 16:48

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