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["成都中医药大学学生入校健康卡"]
["基本信息","姓名",null,"性别",null,"学院",null,"年级"]
[null,"学号",null,"联系方式",null,"家庭住址"]
["填报信息"]
["时间","自身身体健康情况（异常包括发热、咳嗽、呼吸困难、乏力、胸闷、嗓子疼等）",null,"家庭密切接触成员健康状况",null,"是否曾前往疫情高、中风险区和境外",null,"是否接触过疫情高、中风险区高危人员",null,"是否曾往中高风险地区所在市、区、县",null,"是否来自确诊病例报告但暂未划定中高风险地区"]
[null,"健康（划√）","异常（详细填写）","健康（划√）","异常（详细填写）","无（划√）","有（详细填写）","否（划√）","是（详细填写）","否（划√）","是（详细填写）","否（划√）","是（详细填写）"]
["*月*日"]
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["健康卡填报承诺：\n    本人承诺上述填报内容为本人及家庭成员真实情况，无隐瞒、虚假、遗漏等。本人对上述填报内容承担相应责任。同时，本人保证遵守防疫管控期间的各项规定，配合并听从各项措施和要求。\n                                                                          承诺人：\n                                                                          时间："]