FAR EASTERN MEMORIAL HOSPITAL
Screening Record
*Required
*Purpose：
* Inquire previous statement

最後填寫日：
Your previous statement is invalid now.
(Please provide your recent symptoms/signs and contact history. Your personal information is available.，Please revise the record if there is any change.。)
姓名重填
*Name：
電話重填
*Telephone：


In order to protect everyone, please fill out the questionnaires.
*Traveling within the past 14 days
*Occupation
*Contacting history within the past 14 days
*Cluster
*Does the patient live in long term care facility?
每日健康管理(陪病者每日需輸入)
*發燒
體溫
*咳嗽
*腹瀉
如有其他症狀，請主動告知醫護人員。
年度考績時間為：