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大勇國小疑似傳染病個案通報
請務必於48小時內完成通報，並於填寫完成後聯絡導師，感謝您的配合
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通報疾病
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腸病毒
A型流感
B型流感
腹瀉
水痘
急性出血性結膜炎(紅眼症)
疥瘡
頭蝨
Other:
症狀簡述
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學生年級
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1
2
3
4
5
6
學生
班級
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3
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13
學生座號
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學生姓名
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出生年月日
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MM
/
DD
/
YYYY
身分證字號
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家長姓名
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連絡電話
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