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CORONAVIRUS TRAVEL HISTORY CONTACT QUESTIONAIRE

您好,感谢您能抽出宝贵的时间来参与此次调查问卷!
Name
    ____________
2. Is your 48h PCR test positive?
yes
No
5. Are you in the middle of “Home Quarantine” for medical observation,is this outing not allowed?
Yes
No
Name
    ____________
Date
    ____________