Testing Partner Carbon Health

Name of Lab/Site Performing Test San Francisco, CA - Stonestown Galleria

Address of Lab
3251 20th Ave #320 San Francisco, CA 94132

Lab Telephone 14154801160

CLIA Number/Waiver

Traveler Information:

Last Name Lacayo Barrios

First Name Mary Ann
Date of Birth (mm/dd/yyyy) 11/03/2020
Sex Female
Nationality (optional)
Passport Number (optional)

Test Information:

Test Performed SARS-CoV-2 (COVID-19) by RT-PCR

Collection Method Anterior Nasal
Provider Sujal Mandavia MD
Specimen Collection Time 04/19/2022 17:27 (America/Los_Angeles)
Result Time 04/20/2022 05:41 (America/Los_Angeles)
Sample Reference ID# 8404167-0
Or
Unique Test Result ID#

Test Result:

Negative
General COVID-19 Letter (Trusted Testing Partner)(v.2.0)