GSI Lab

Registered Office: Graha Mitra, 4th Floor, Jl. Jend. Gatot Subroto Kav. 21, Jakarta 12930, Indonesia
Lab Address: Jl. RA Kartini No 34, Cilandak Jakarta 12430, Indonesia
Instagram : @gsilab.id Email : helpline@gsilab.id
www.gsilab.id

Patient: ANGGRAINI ERDIYANTY TANJUNG

Dusun II Kec. Beringin, Lubuk Pakam Drive Thru GSI by Medika Plaza

GSI WEB Org

: B6572572

: 10-December-1993

: +6281396924354

: Anggrasetiawan57@gmail.com

: Female

100-019-0031 (187466) Date Received : 26-January-2021

Swab, Naso-Oropharyngeal Date Reported : 27-January-2021
26-January-2021

Test Result Normal Range Date Approved

PCR SARS-CoV-2 Negative Negative 27-Jan-2021

E Gene Negative Negative
E Gene Ct -
RdRp Gene Negative Negative
RdRp Gene Ct -

: dr. Siskawati Suparmin, Sp.PK.

27-January-2021

Page 1 of 1 Print Date: 27-Jan-2021

 SURAT KETERANGAN DOKTER
MEDICAL CERTIFICATE
Yang bertandatangan dibawah ini dokter Laboratorium Genomik Solidaritas Indonesia (GSI Lab), menyatakan bahwa :
The undersigned, the Genomik Solidaritas Indonesia Laboratory Physician (GSI Lab), explains that:

Nama / Name : ANGGRAINI ERDIYANTY TANJUNG

NIK / Local ID : B6572572

Tanggal Lahir / DOB : 10-December-1993
Domisili / Address : Dusun II Kec. Beringin, Lubuk Pakam

Perusahaan / Company : GSI WEB Org

Fasyankes / Provider : Drive Thru GSI by Medika Plaza

Dilakukan pemeriksaan :

Sampel / Sample # : 100-019-0031 (187466) Tgl Penerimaan / Date Received : 26-Jan-2021

Sumber / Source : Swab, Naso-Oropharyngeal Tgl Pelaporan / Date Reported : 27-Jan-2021
Tgl Pengumpulan / Date Collected : 26-January-2021

Test Result Normal Range Date Approved

PCR SARS-CoV-2 Negative Negative 27-Jan-2021

E Gene Negative Negative
E Gene Ct -
RdRp Gene Negative Negative
RdRp Gene Ct -

Demikian surat keterangan ini dibuat untuk digunakan sebagaimana mestinya.

This certificate is made to be used as intended.

Terimakasih atas perhatiannya,

Thank you for your attention,
Pindai untuk periksa keaslian dokumen
Scan to check document's originality

Hormat kami,
Sincerely,

Jakarta, 27 January 2021

dr. Siskawati Suparmin, Sp.PK.

SIP No. 93/B.15B/31.74.06.1001.06.005.K.3.a.b/3/-1.779.3/e/2020

PT. Genomik Solidaritas Indonesia
Registered Office: Graha Mitra, 4th Floor, Jl. Jend. Gatot Subroto Kav. 21, Jakarta 12930, Indonesia
Lab Address: Jl. RA Kartini No 34, Cilandak Jakarta 12430, Indonesia
T : +6221 5020 9090 F : +6221 2557 9889