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["            托育园家长行动轨迹健康档案记录表 (入园前14天）          家长姓名：        与幼儿关系："]
[null,"期间是否外出(旅居史情况如有，请具体填写)",{"$nulls":7},"学生及共同居住人接触史",null,"健康状况"]
["日期","是否已返渝","返渝路线（途经哪些地方）","返渝乘坐的交通工具（班次、航班、车牌）","返渝到达时间（年月日）","是否报告社区","是否按社区要求执行","隔离的起止时间","未居家隔离的，目前去向","有无接触中高风险区人员","有无接触过确诊或疑似病例","体温是否正常","有无发热咳嗽乏力、鼻塞、流涕咽痛、腹泻等症状"]
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["幼儿姓名：                                                                                                                                                         联系电话："]