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["预约       月     日（三）HPV第（   ）针接种疫苗的人员登记表"]
["序号","单位名称","姓名","工号/学号","身份证号码","人员类别","是否完成居家观察","隔离期满日期","流行病学史","是否本校人员","手机号"]
["例","地球物理学院","丁一",2019210000,"23***************8","学生","是","2020.2.13或未离京","无","是","1891*****45"]
[1]
[]
["流行病学史：",null,null,"②是否有武汉市及周边地区、张家口市及周边地区、疫情高发国家（美国、韩国、意大利、西班牙、伊朗、日本等），或其他有病例报告社区的旅行史或居住史"]
["（没有相关疫区或病例接触史，则填“无”，如有则如实填写具体内容）",null,null,"③是否与新型冠状痛毒感染者(核酸检测阳性者)有接触史"]
[{"$nulls":3},"④是否曾接触过来自武汉市及周边地区、张家口市及周边地区、疫情高发国家（韩国、意大利、伊朗、日本等）或来自有病例报告社区的发热或有呼吸道症状的患者"]
[{"$nulls":3},"⑤是否聚集性发病(2周内在小范围如家庭、办公室、学校班级等场所，出现2例及以上发热和/或呼吸道症状的病例)"]