GERONA MATERNITY CLINIC

#3 Poblacion 2 Gerona, Tarlac 2302

Tel. No. (045) 931-3657

Name: ________________________________________ Age: _____

Address: ______________________________________ Date Performed:________________
Requesting Physician : ___________________________

DATE PERFORMED: _____________________________

Examination Result Remarks

ANTIGEN TESTING Nasopharyngeal Swab

SARS-COC-2 Antigen Rapid Test
______________________________________________________________________________

Interpreted by:

______________________
Gladys B. Ablang, M.D.
Obstetrician and Gynecologist
License No: 70654