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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 : [email protected]
www.gsilab.id
Keputusan Direktur Jenderal Pelayanan Kesehatan 24/7 Helpline +62-21-8086 6080 & WA +62-82
Brought to you by
Nomor: HK.02.02/I/2932/2020 1-2233-6080

Patient: AGUS SUPRIYADI Provider:


Dusun 9 Girimulyo, Marga Sekampung, Lampung Timur GSI MEDIKA PLAZA CILANDAK
Corporate:
GSI WEB Org
Local ID / NIK : 6171015109830007

Date of Birth : 15-Agustus-1986

Telephone : +6281294408384

Email : [email protected]

Gender : Male

Report # :
Customer Reference # : 1000400454020721

Sample # : 100-054-8295 (546307) Date Received : 13-July-2021


Source : Swab, Naso-Oropharyngeal Date Reported : 14-July-2021
Date Collected : 13-Jul-2021 20:35 GMT +7

Test Result Normal Range Date Approved

RT-PCR SARS-CoV-2 Negative Negative 14-Jul-2021


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

Approved By : dr. Anindya P. Susanto, B.Eng, MM.


14-July-2021

Page 1 of 1 Print Date: 14-Jul-2021

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