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["滕州五中新冠肺炎疫情防控学生“一人一案”健康监测和出行记录表"]
["学生姓名",null,"性别",null,"身份证号",null,null,null,"年级/班级",null,"家庭住址"]
["家庭成员","父亲姓名",null,null,"工作单位",null,null,null,"联系电话",null,"其他家庭成员"]
[null,"母亲姓名",null,null,"工作单位",null,null,null,"联系电话"]
["排查内容（符合以下条件的学校师生员工进行核酸检测，检测合格后，经学校批准可返校上课， 未经学校批准不得返校）"]
["（1）有发热等可疑症状的  □是 □否；（2）本人或家庭成员为密（次密）接者的  □是 □否；（3）10天内本人或家庭成员有疫情中高风险地区（含境外）旅居史、接触史的  □是 □否；（4）21天内所居住社区（村居）发生疫情的  □是 □否。    有以上情况之一者是否核酸检测  □是 □否"]
["每日行踪和身体健康状况登记一览表（开学前10天返回学校驻地，非必要不得离开枣庄）"]
["项目","身体状况",{"$nulls":4},"是否核酸检测","本人出行情况",null,"本人疫情中高风险地区（含境外）旅行史、接触史情况",null,"同居住家庭成员接触疫情中高风险地区（含境外）旅行史、接触史情况"]
["日期（月/日）","健康","发热≥37.3度","咳嗽","乏力","其它"]
["2022-08-20"]
["2022-08-21"]
["2022-08-22"]
["2022-08-23"]
["2022-08-24"]
["2022-08-25"]
["2022-08-26"]
["2022-08-27"]
["2022-08-28"]
["2022-08-29"]
["2022-08-30"]
["学生监护人承诺以上内容属实，如隐瞒、虚报，本人承担一切法律责任或相应后果。学生监护人（签字）：                班主任审核（签字）："]

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