20201224023425-Unlocked

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GSILab

RegisteredOffice:GrahaMitra,4thFloor,Jl.Jend.GatotSubrotoKav.21,Jakarta12930,Indonesia
Lab Address: Jl. RA Kartini No 34, Cilandak Jakarta12430,IndonesiaInstagram : @gsilab.id Email :helpline@gsilab.id
www.gsilab.id

KeputusanDirekturJenderalPelayananKesehatan Brought to you by 24/7Helpline+62-21-80866080&WA+62-821-2233-6080


Nomor: HK.02.02/I/2932/2020

Patient:NAURAKHAIRIYAH Provider:
Perumahan Pondok Benda Indah Blok S1 No.17 Rt.003/Rw.019 Kel. Benda Baru, Kec.Pamulang, Kota
Drive Thru GSITangerang
by MedikaSelatanBanten
Plaza

Corporate:
GSI WEB Org
Local ID/NIK:3674064206020007
DateofBirth: 02-June-2002
Telephone: +6281510019770
Email:etikpusparini@yahoo.com
Gender:Female

Report # :
Customer Reference# : 1000203613231220

Sample # Source 100-023-7407


: (236084) DateReceived :23-January-2021
DateCollected Swab,
: Naso-Oropharyngeal 23-January-2021 DateReported :24-January-2021
:

Test Result Normal Range Date Approved

PCR SARS-CoV-2
Positive Negative 23-Jan-2021
E Gene Positive Negative
E Gene Ct 28.6
RdRp Gene Positive Negative
RdRp Gene Ct 30.39

ApprovedBy : dr. Siskawati Suparmin, Sp.PK.


24-January-2021

Page 1 of 1 Print Date: 24-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 : NAURAKHAIRIYAH

NIK /LocalID : 3674064206020007


Tanggal Lahir/DOB :02-June-2002
Domisili/Address :
Perumahan Pondok Benda Indah Blok S1 No.17 Rt.003/Rw.019 Kel. Benda Baru, Kec.
Pamulang, Kota Tangerang Selatan Banten
Perusahaan/Company : GSI WEBOrg

Fasyankes/Provider : Drive Thru GSI by Medika Plaza

Dilakukan pemeriksaan:

Sampel / Sample # : 100-023-7407 (236084) Tgl Penerimaan / Date Received : 23-Jan-2021


Sumber / Source : Swab, Naso-Oropharyngeal Tgl Pelaporan / Date Reported : 24-Jan-2021
Tgl Pengumpulan / Date Collected : 23-Jan-2021

Test
Result Normal Range Date Approved

PCRSARS-CoV-2 Positive Negative 23-Jan-2021


EGene Positive Negative
EGeneCt 28.6
RdRpGene Positive Negative
RdRpGeneCt 30.39

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, 23 January 2021

dr. Siskawati Suparmin, Sp.PK.1

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

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