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[null,"广东茂名农林科技职业学院2021年高职扩招考生健康卡"]
[]
[null,"姓  名",{"$nulls":4},"籍   贯"]
[null,"性  别",{"$nulls":4},"报考专业"]
[null,"联系电话",{"$nulls":4},"居住地（近14天）"]
[null,"近14天是否到过疫情中、高风险地区",null,"是（ ）否（  ）",null,null,"近14天是否接触过涉疫人员或疑似病例",null,null,"是（ ）否（  ）"]
[null,"返校旅程信息（交通方式、班次信息等）"]
[null,"返校前14天身体健康情况"]
[null,"日期","体温",null,"健康情况（有无呕吐，咳嗽、腹泻等症状）",null,"日期","体温",null,"健康情况（有无呕吐，咳嗽、腹泻等症状）"]
[]
[null,null,"上午：",{"$nulls":4},"上午："]
[null,null,"下午：",{"$nulls":4},"下午："]
[null,null,"上午：",{"$nulls":4},"上午："]
[null,null,"下午：",{"$nulls":4},"下午："]
[null,null,"上午：",{"$nulls":4},"上午："]
[null,null,"下午：",{"$nulls":4},"下午："]
[null,null,"上午：",{"$nulls":4},"上午："]
[null,null,"下午：",{"$nulls":4},"下午："]
[null,null,"上午：",{"$nulls":4},"上午："]
[null,null,"下午：",{"$nulls":4},"下午："]
[null,null,"上午：",{"$nulls":4},"上午："]
[null,null,"下午：",{"$nulls":4},"下午："]
[null,null,"上午：",{"$nulls":4},"上午："]
[null,null,"下午：",{"$nulls":4},"下午："]
[null,"新冠疫苗接种情况"]
[null,"第一针接种日期",{"$nulls":4},"第二针接种日期"]
[]
[null,"声明：本人对上述填报内容真实性负责，如有不实，本人愿意承担一切责任。"]
[{"$nulls":6},"本人签名："]
[null,"备注：\n1、到校学员如实填写个人14天健康状况，电子档于返校前报所班主任，纸质版亲笔签名并在返校时交班主任。\n2、请在此表格背面附上健康码截图、行程卡截图、48小时内核酸检测报告截图。"]
[]
[null,"个人防控信息截图"]
[]
[null,"粤康码截图：",{"$nulls":4},"行程卡截图："]
[null,"在此粘贴截图",{"$nulls":4},"在此粘贴截图"]
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[null,"核酸检测报告截图）："]
[null,"非茂名本地考生（跨市考生）或14天内离开过茂名的考生需提供"]

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