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["个人健康信息承诺书"]
[]
["姓名：            身份证号：               准考证号："]
["天数","日期",null,"A、本人、家人及共同居住人员是否存在发热、乏力、咳嗽、呼吸困难、腹泻等病状","B、是否有国内疫情中、高风险地区或国（境）外旅居史","C、是否密切接触人员"]
["第1天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第2天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第3天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第4天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第5天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第6天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第7天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第8天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第9天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第10天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第11天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第12天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第13天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["第14天"," 月  日",null,"是□   否□","是□   否□","是□   否□"]
["考生进入考点时检测的体温",{"$nulls":3},"℃（该项由工作人员填写）"]
["从外地到考试城市的日期、出发地、途径地、交通方式（车次）、居住宾馆，请在右侧栏详细描述。（无此类情况请填“无”）"]
["考生承诺",null,"本人承诺：以上所填内容真实、准确、完整，如隐瞒、漏报情况造成危及公共安全后果，本人将承担相应的法律责任，自愿接受《治安管理处罚法》、《传染病防治法》和《关于依法惩治妨害新型冠状病毒感染肺炎疫情防控违法犯罪的意见》等法律法规的处罚和制裁。"]
["打印后，本人签字。                       签字："]

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