MEDICAL RECORD Patient Facility Patient Oscar Ghelber DOB 10/19/1962 Sex Male Address 6912 SPRING VALLEY WAY FORT WORTH, TX 76132 Phone 682-346-0288 Email oscarghelber@icloud.com Passport ID 567476251 Passport Country UNITED STATES Facility Covid Clinic Facility Director Matthew Abinante, Do, Mph Facility Address 17304 PRESTON RD SUITE 800 DALLAS, TX 75252 Facility Phone 8772198378 Facility Email info@covidclinic.org Facility CLIA 45D2222930 Ordering Provider Covid Clinic Ordering Provider Address 17304 PRESTON RD. SUITE 800 DALLAS, TX 75252 Test Details Specimen ID 00-3647557-04 Test Name In Vitro test Utilizing RT-PCR and Lateral Flow Test Device Accula Dock Collection Date 02/03/2022 10:07 CST Test Date 02/03/2022 10:42 CST Test Results SARS-CoV-2 NEGATIVE Information Interpretation NEGATIVE RESULTS DO NOT PRECLUDE SARS-COV-2 INFECTION. Clinical correlation is required. INVALID Submit another sample if clinically indicated. The SARS-CoV-2 RNA is detectable in respiratory specimens during the acute phase of infection. POSITIVE Results are indicative of active infection. Disclaimer The RT-PCR test was performed with a Mesa Biotech Inc. Accula SARS-CoV-2 Test. The RT-PCR technology for this test was developed for specific detection of SARS-CoV-2 (COVID-19) viral RNA extracted from nasal and nasal midturbinate. This test has been authorized by the FDA under Emergency Use Authorization (EUA). The EUA was issued on 3/23/2020. Limitations Negative results do not preclude COVID-19 infection. A false negative result may occur if the specimen is collected, transported or handled improperly, or if amplification inhibitors or mutations are present in the specimen or primer/probe binding site, respectfully. Detection of viral RNA may not indicate the presence of infectious COVID-19 as the causative agent for clinical symptoms. The test cannot rule out disease caused by other bacterial or viral pathogens. Information sourced from: https://www.fda.gov/media/136355/download The information contained in this document may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited.