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["附件2："]
["贵阳市口腔医院人员招聘新冠肺炎疫情防控表"]
[]
["基本信息",{"$nulls":3},"到院信息",null,"近14天内，您是否有以下症状",{"$nulls":7},"14天内是否有中高风险地区旅居史？","如果14天内有中高风险地区旅居史，请填写具体地址","是否为境外返回人员？","如果为境外返回人员，请填写具体国家","一个月内是否接触过新冠确诊、疑似或无症状感染者？","14天内是否接触过来自境外或中高风险地区的有发热或呼吸道症状的患者？","如果14内接触过来自境外或中高风险地区的有发热或呼吸道症状的患者，请填写最后接触时间","近14天内家庭成员、同事、朋友等密切接触的人员中有无2例及以上的发热、咳嗽等呼吸道症状患者？"]
["姓名","性别","身份证号","联系电话","出入时间",null,"发热（≥37.3℃）","咳嗽","嗓子痛（咽痛）","胸闷","呼吸困难","恶心呕吐","腹泻□其他症状","无症状"]
[{"$nulls":4},"  月  日\n至\n  月  日",{"$nulls":10},"______市______区街道(乡镇)______社区",null,"国家名称_________，返回时间________",null,null,"  月\n  日"]
[]
["    本人已悉知疫情防控要求，对上述提供的健康相关信息的真实性负责。如因不实信息引起疫情传播和扩散，本人愿承担由此带来的全部法律责任。\n\n\n\n                                                                  承诺人：                         日期：    年   月   日"]