首頁資訊個人健康情況聲明Health Status Statement

個人健康情況聲明Health Status Statement

來源：泰然健康網(wǎng) 時間：2025年05月20日 19:28

請考生仔細(xì)填寫，謝謝合作
Please fill out the questionare and sign this statement. Thank you.

*2.

本人目前身體狀況 Health Status

身體健康 Healthy發(fā)熱 Fever咳嗽 Cough乏力 Tired其他 Other

*3.

您的共同居住人是否有發(fā)熱、咳嗽、乏力、呼吸困難等癥狀 Do(es) your co-resident(s) have symptoms such as fever, cough, fatigue, and difficulty in breath?

是 Yes否 No

*4.

本人及共同居住人14天內(nèi)是否接觸過確診、疑似或已被隔離人員本人及共同居住人14天內(nèi)是否接觸過近期境外回國人員 Have you and your co-resident(s) had direct contact with confirmed, suspected or quarantined person within 14 days?

是 Yes否 No

*5.

本人及共同居住人14天內(nèi)是否接觸過近期境外回國人員 Have you and your co-residents had direct contact with recent returnee(s) from overseas?

是 Yes否 No是否

*7.

考試日期 Administration Date

（請按照年、月、日的順序填寫）(mm/dd/yy)

*9.

緊急聯(lián)系人電話 Emergency Contact

不得與本人電話相同，一旦出現(xiàn)特殊情況，必要時考點(diǎn)將與緊急聯(lián)系人取得聯(lián)系 Please leave a different number from your phone number, just in case we need to contact this person in any emergency.

*10.

以上內(nèi)容為本人認(rèn)真填寫，如存在隱瞞事實情況，由此產(chǎn)生的一切后果及遭受的經(jīng)濟(jì)損失均由本人獨(dú)自承擔(dān)，與考點(diǎn)沒有任何關(guān)系。
The above content is carefully filled in, if there is any concealment, I will personally bear all the consequences.

一旦參加考試，本人在考試期間或考后發(fā)生異常情況，而經(jīng)考點(diǎn)核實屬于考前即存在未愈的病情情況，責(zé)任由本人承擔(dān)。
Once I take the test, if any abnormal situation on me during and after the test had been verified by the test center to be unhealed condition, I will personally bear all the consequences.

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