In accordance with Taiwan CDC’s policy and in order to protect the health of all participants, all participants who join in this program must cooperate to fill in the “Health Care Survey”. Your personal data collected by us via this survey contains your personal identification information (i.e., your name), medical records, healthcare data, contact information, data concerning your social activities, and other data that is necessary for us to take antiepidemic measures. Your personal data will not be used for any purpose other than the aforementioned epidemic prevention purposes.

*If you have any COVID-19 related symptoms, especially those who returned from abroad recently, please go to the nearest hospital for the examination, or any medical assistance.


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姓名Name(as shown on passport) *
e-mail *
現居地址/宿舍 Current Address/Dormitories *
過去30天內去過哪些國家(含港澳地區),如無可略過此題Please fill in all countries (including Hong Kong and Macao) you have been to during the past 30 days. (If no, you can skip the question.)
呈上題,近一次入境臺灣日期為? Following the previous question, please tell us the date of your last arrival into Taiwan.
如上題為無,可略過此題 You can skip the question if the answer is NO in the previous question.  
您是否接受過新冠肺炎篩檢?Have you received a COVID-19 screen test? *
承上題,如有請填篩檢日期,篩檢醫療院所與結果,如無可略過此題 If yes, please fill in the date when the test was taken, the medical institute, and the results. (If no, you can skip the question.)
您是否曾與感染新冠肺炎病患接觸?Have you ever in any physical contact with the COVID-19 patients ? *
您是否近一個月內,曾與居家檢疫/居家隔離的人接觸?Have you contact or meet with person who is home quarantine/self-quarantine during the past month? *
您是否已施打疫苗 Have you been vaccinated yet?
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