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POLIKLINIK SAMUDERA SITIAWAN (S!

_TIAWAN)
NO ~ fAIIAN SlflA~ N MA.JU 2, " SITIAWAN"':°ERAK
No. Tel£.\: 05-692~ ! ! :NG r!Ja,. . . ri@gmall.com

\J~ ~ ~RY REQUEST FOR RESPIRATORY VIRUS~'s-ri . } /rl ~


\_~ Laboratory Reference ID : RTK11791/CVD/21/2284 ~
Patlenl ame ~
Paf t ID
~ ; ; : !ZANI BIN ABDUL RAZAK
.,900917085389
Go_,
Nationality
, Molo
: Malaysian
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~
V
CategorylD :-iN RIC Pesaklt Age : 30 Year & 11 Month ~....

~ \5:'.?
0
, PdOllnlk Sanwd~ """l(Re!e.._ ...,. , Peral<
emo on No. : DR SUNDRASAN MUTHOO)
Llnfoocatlon n : POUKLiN IK SAMUDERA SITIAWAN Name of the : DR SUNDRASAN MUTHOO
Requeator

B \T
Pe ohon ranslt -1
: _
Date Received
Specimen In Lab
. 13-09-2021

I Specimen Particulars

I Type of Specimen II Date & Time (24 hour format) Specimen Taken
Naso Pharyngeal Swab II 13-09-2021 (Mass : 11:00:00 )

i:=:;::=~==~11:==::;\;:::=li=
\ RESPIRATORY VIRUS TEST RESULT

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=•=ted
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13-0
Rap~ tlgen Test Test Name : Coronavlrus Sundrasan All Muthoo Time Verified:
Test Result ; Ni~ Pegawal Perubatan 11:4"0:11
(24 Hbur F.o )
Remarks :

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