Bartholy Jacques

MEDPLUS FAMILY MEDICAL CENTER

Tel: 509 3 193 6868

Email: medplushaiti@gmail.com

Facebook | Twitter: @medplushaiti

 

SARS-CoV-2 Test – Result Certificate

 

Name:               [    ]                                                                                  Date of birth: [dd/mm/yyyy]

Gender: [  ]                                                                               Passport number: [    ]

 

Specimen Type Specimen Date Test
Nasopharyngeal Swab [         ] Rapid Antigen

 

Date reported: [   ]

Result:  SARS-CoV-2    [     ]

Sample tested using CareStart COVID-19 ANTIGEN approved for the detection of SARS-CoV-2

 

TESTING CENTER: MEDPLUS FAMILY MEDICAL CENTER

 

 

Date: [   ]                                                                                     Signature:

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