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["附件"]
["疫情防控期间体检联系单"]
[]
["姓  名",null,null,"性别",null,"年龄"]
["身份证号",null,null,"联系电话"]
["身份证住址"]
["现住址"]
["就业单位","南京市栖霞区教育局所属学校"]
["体检类别","1.从业人员健康体检                                     （食品、生活饮用水、公共场所、消毒产品、化妆品）",{"$nulls":4},"2.√入职体检"]
["体检当天体温（医院测量）",null,"是否有感冒、流涕、咽痛、发热、咳嗽、乏力等症状"]
["相关证明"]
["    1.14天内有无北京或其他有病例报告地区旅居史： 1.有   2.无"]
["    2.14天内是否接触过来自北京或其他有病例报告地区的发热或有呼吸道症状的患者： 1.有   2.无"]
["    3.14天内是否从境外回国或来华： 1.是   2.否"]
["    4.14天内是否接触过境外回国或来华的人员：1.是  2.否"]
["    5.体检当天无发热、咳嗽、乏力等症状"]
["    特别提醒：根据《传染病防治法》《治安管理处罚法》等法律规定，如果您隐瞒上述情况或者拒绝配合医务人员开展调查等处置措施的，将承担相应法律责任。"]
["    我已知晓并确认上述内容！"]
[]
[]
[]
["个人签字："]
[]
[]
["                          日   期（必填）： 2020年7月      日"]

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