Patient Details Specimen Details Physician Details

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1 Patient Report 

  
Specimen ID: 148-229-6453-0 Acct #: 04115970 Phone: (909) 677-7168 Rte: 00
Control ID: PRP04115970
SBDPH_WH
RAMOS SYLVIA 247 S BOYD STREET
10796 PEMBERTON ST SAN BERNARDINO CA 92415


ADELANTO , CA 92301
(909) 496-1977

Patient Details Specimen Details Physician Details


DOB: 09/16/1978 Date collected: 06/22/2020 1230 Ordering: E GUSTAFSON
Age(y/m/d): 041/08/16 Date received: 06/23/2020 Referring:
Gender: F Date entered: 06/23/2020 ID:
Patient ID: Date reported: 06/25/2020 2005 ET NPI: 1770877060
Ordered Items
SARS-CoV-2, NAA; Please note
TESTS RESULT FLAG UNITS REFERENCE INTERVAL LAB
SARS-CoV-2, NAA Detected Critical Not Detected 01
This test was developed and its performance characteristics determined
by LabCorp Laboratories. This test has not been FDA cleared or
approved. This test has been authorized by FDA under an Emergency Use
Authorization (EUA). This test is only authorized for the duration of
time the declaration that circumstances exist justifying the
authorization of the emergency use of in vitro diagnostic tests for
detection of SARS-CoV-2 virus and/or diagnosis of COVID-19 infection
under section 564(b)(1) of the Act, 21 U.S.C. 360bbb-3(b)(1), unless
the authorization is terminated or revoked sooner.
When diagnostic testing is negative, the possibility of a false
negative result should be considered in the context of a patient's
recent exposures and the presence of clinical signs and symptoms
consistent with COVID-19. An individual without symptoms of COVID-19
and who is not shedding SARS-CoV-2 virus would expect to have a
negative (not detected) result in this assay.

Please note 02
The date and/or time of collection was not indicated on the
requisition as required by state and federal law. The date of
receipt of the specimen was used as the collection date if not
supplied.

01 CETWE LabCorp Phoenix Dir: Earle Collum, MD


5005 S 40th St, Phoenix, AZ 85040-2969
02 SO LabCorp San Diego Dir: Jenny Galloway, MD
13112 Evening Creek Dr So Ste 200, San Diego, CA
92128-4108
For inquiries, the physician may contact Branch: 800-859-6046 Lab: 800-788-9743

Date Issued: 06/25/2020 211 ET FINAL REPORT Page 1 of 1


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