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Final Report Date :

Patient Information

Name of Patient : xxxx

Gender : xxxx

Phone Number : xxx-xxx-xxxx

Address : xxx-xxx-xxxx

City : xxx-xxx-xxxx

Zip Code : xxx-xxx-xxxx

Test Information : xxxx

Specimen Source : xxxx

Clinician : xxx-xxx-xxxx

Collected : xxx-xxx-xxxx

Result: xxx-xxx-xxxx

Diagnosis Code: xxx-xxx-xxxx

CPT/Procedure Code: xxx-xxx-xxxx

Result (Abnormal) Flag UOM REFERENCE RANGE
SARS-COV-2(RT-PCR)

Negative

This patient was tested using a fully integrated device containing a reverse transcription polymerase chain reaction (RT-PCR) based assey for qualitative detection of vural RNA from the SARS-CoV-2 virus. The device automatically performs all steps required to complete lysis,reverse transcription polymerase chain reaction,and amplificaton

Vechile Type: xxx-xxx-xxxx

Passport Number: xxx-xxx-xxxx

Passport Exp: xxx-xxx-xxxx

DL State and Number: xxx-xxx-xxxx

DL Exp: xxx-xxx-xxxx

Test Performed At:

ProscriptAmerica Inc

1801 Binz St. Suite 310, Houston, TX 77004

 Phone: (281) 816-6501

 Email: [email protected]

*** Final Report ***