已通報後每日自主健康管理體溫紀錄表
請自主健康管理, 且須「每日早晚」測量體溫並登錄
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姓名 Name *
身分證字號或居留證號 ID No or ARC No *
體溫監測起始日期(第一天) Start Date (First Day of Body Temperature Measurement） *
MM
/
DD
/
YYYY
今日體溫測量日期 Date (Today) *
MM
/
DD
/
YYYY
今日體溫測量時間 Time (Body Temperature Taken) *
Time
:
請填寫體溫測量溫度 Today's Body Temperature *
今日有無出現上呼吸道症狀(如：鼻塞、流鼻水、咳嗽) 或腹瀉、失去嗅覺味覺Any Respiratory Disease Symptoms? (Such as stuffy nose, runny nose, cough and etc) *
今日是否曾經外出，外出地點請於其他欄位說明(住家附近超商、醫院等) Did you go out today? If yes, please indicate the places you went (such as nearby convenience store, hospital and etc.) *
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