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確診者足跡調查
請仔細回想您最早出現症狀的發病日期(如沒有症狀者填否)及確診日期(快篩及PCR陽性日期)並紀錄從發病(確診)日期的前兩天到您被隔離前這段期間,與接觸者任一方未配戴口罩超過15分鐘以上的情況下接觸的人、接觸的時間及地點。
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班級
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學號
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姓名
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連絡電話
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連絡電話2
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確診日期
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MM
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DD
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YYYY
居家隔離地址
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是否出現症狀
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是
否
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