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CDMDL 22 025288

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CITY OF DASMARIÑAS MOLECULAR DIAGNOSTIC

LABORATORY
Brgy. Langkaan II, sitio Humayao City of Dasmariñas, Cavite
Email: molecularlab.pd@gmail.com

COVID-19 RT-PCR LABORATORY RESULT FORM


Name of Patient: VILLAREAL, JOHN ROIE CUMAL Patient Location::
(Last name, First name, Middle name) [ ] OPD [ ] REFERRAL [ ]
INPATIENT

Age/Gender 20 Y / MALE Date of Birth: 12/27/2001 Nationality: FILIPINO


(MM/DD/YYYY)

Civil Status: SINGLE Complete Address: BLK 1 LT 11, VILLE DE SOLEIL, CITY OF DASMARIÑAS, LANGKAAN I,
CAVITE, REGION IV-A (CALABARZON)

Contact No.: +639695896630 Email Address: marcjeswon@gmail.com Accession No.: CDMDL-22-025288

Specimen Type: NPS/OPS Disease Reporting Unit: PAGAMUTAN NG DASMARIÑAS Laboratory No.:

Date and time of specimen collection Date and time of Specimen Receipt:
(MM/DD/YYYY HH:MM) (MM/DD/YYYY HH:MM)
12/06/2022 9:39 AM 12/06/2022 1:28 PM

Date and Time of Release of Result:


(MM/DD/YYYY HH:MM)
12/06/2022 8:38 PM

LABORATORY TEST RESULT

LABORATORY TEST PERFORMED: SARS-CoV-2 (causative agent of COVID-19) virus detection by Real-Time Polymerase
Chain Reaction

TEST RESULT: SARS-CoV-2 (causative agent of COVID-19) viral RNA not detected

INTERPRETATION OF RESULTS:

FINAL RESULT INTERPRETATION


SARS-CoV-2 (causative agent of COVID-19) viral RNA

detected Positive for SARS-CoV-2 (causative agent of Covid-19) SARS-CoV-2 (causative agent of COVID-19) viral
RNA not

detected Negative for SARS-CoV-2 (causative agent of Covid-19) Invalid due to specimen quality Negative for test internal
control (due to poor specimen quality)

*This laboratory result should be interpreted by a qualified physician with the available clinical and epidemiological information.

Comments:

Scan Here

Performed By: Verified By: Validated & Approved By:


RHALL JASON M. JARED IMMANUELLE P. FLORECITA LUDIVINA T. SOLIS
MONTEVIRGEN RMT, MLS ALMONTE RMT MD, FPSP
(ASCPI) Quality Assurance Officer License No: 0080537
Medical Technologist License No: 0088506
License No: 0093120

MA. TERESA A. BARZAGA MD,


FPSP License No: 0053188

FRANCIS CARLO MELMON Pathologists


RMT Medical Technologist
License No: 0075664

THIS IS A COMPUTER GENERATED REPORT. Doc control #: CDMDL-SOP-FM-01

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