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COVID-19自費病毒核酸檢驗預約申請 2/4-2/12for Out-of-Pocket COVID-19 NAAT Testing Appointment
＊急件4500元 Urgent case NT $4,500
＊普件3500元 Regular case NT $3,500
＊請在檢查日期前一天的中午12點之前填寫預約表，逾時您的申請將被視為無效。
＊Please complete the appointment form before 12 p.m that on the day before the inspection date you specified, or your application will be deemed invalid if you late to do so after the deadline.
*本院聯繫窗口電話：07-5562217分機1102~1104
*TEL：07-5562217#1102~1104
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Email
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Your email
報告件別屬性
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取件地點為篩檢站櫃台 Please pick-up the report at screening station counter.
急件(限掛號上午時段)：採檢當日17:00前可領取(有特殊情況，將另行通知) Urgent case(Only available for registered in the morning): The report will be available to pick-up after 5 p.m. on the same day.
普件(前一日採檢，隔日中午12:00前領取) Regular case: The report will be available to pick-up before 12 p.m on the next day.
預約檢查日期&時段選擇
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Screening Date Appointment & Screening Time Selection
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2021/1/24 09:00-1100
2021/1/24 14:30-16:00
2021/1/25 09:30-11:00
2021/1/25 14:30-16:00
2021/1/26 09:30-11:00
2021/1/26 14:30-16:00
2021/1/27 09:30-11:00
2021/1/27 14:30-16:00
2021/1/28 09:30-11:00
2021/1/28 14:30-16:00
2021/1/29 09:30-11:00
姓名（本國籍人士請填寫中文姓名）
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Name (Please fill in the name of original nationality.)
Your answer
英文名（與護照相同）
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Name in English: Please fill in the name in English according to the passport.
Your answer
性別
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Gender
女 Female
男 Male
身分證字號/護照號碼/通行證號
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National ID No. / Passport No. / ARC or APRC No.
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生日
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Date of Birth (AD Year)
MM
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DD
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YYYY
手機號碼
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Mobile
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住址
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Add.
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過去14天內是否有發燒、咳嗽、呼吸急促、喉嚨痛、流鼻水、鼻塞、腹瀉、嗅/味覺異常、全身倦態 四肢無力症狀 ？
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Have you had fever, cough, shortness of breath, sore throat, runny nose, stuffy nose, diarrhea, smell/taste abnormal, fatigue and weak etc. in the past 14 days?
是 Yes 如有發燒、相關旅遊史、群聚接觸史的病人，建議至專責醫院就醫。
否 No
在過去21天內是否有出國旅遊史或接觸COVID-19確診病人。
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Have you had ever travel or contacted with people who is COVID-19 confirmed case during the past 21 days?
是 Yes 如有發燒、相關旅遊史、群聚接觸史的病人，建議至專責醫院就醫。
否 No
聲明 Statements
本人保證所填資料屬實，若有隱匿將接受傳染病防治法等法規之追訴究責。
I hereby declare that the particulars and answers to the questions given in this Declaration are true and correct to the best of my knowledge and belief.
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