1.Exit or Entry 出入境类型 Exit 出境 1.Exit or Entry 出入境类型 Entry 入境 3.Gender 性别 Male 男 3.Gender 性别 Female 女 Please select the Mobile number type:请选择手机号类型：Chinese 境内 Please select the Mobile number type:请选择手机号类型：Overseas 境外 Have you had direct contact with confirmed/suspected/symptomless cases of COVID-19 during the past 14 days:过去14日内至今，曾接触新冠肺炎确诊病例/疑似病例/无症状感染者：Yes 是 Have you had direct contact with confirmed/suspected/symptomless cases of COVID-19 during the past 14 days:过去14日内至今，曾接触新冠肺炎确诊病例/疑似病例/无症状感染者：No 否 Have you had direct contact with people having fever and/or symptoms of respiratory infection during the past 14 days:过去14日内至今，曾接触有发热和/或呼吸道症状的患者：Yes 是 Have you had direct contact with people having fever and/or symptoms of respiratory infection during the past 14 days:过去14日内至今，曾接触有发热和/或呼吸道症状的患者：No 否 Has your community reported any COVID-19 cases during the past 14 days:过去14日内至今，所居住社区曾报告有新冠肺炎病例：Yes 是 Has your community reported any COVID-19 cases during the past 14 days:过去14日内至今，所居住社区曾报告有新冠肺炎病例：No 否 Have there been two or more members in your office/family having fever and/or symptoms of respiratory infection during the past 14 days:过去14日内至今，所在办公室/家庭等是否出现2人及以上有发热和/或呼吸道症状：Yes 是 Have there been two or more members in your office/family having fever and/or symptoms of respiratory infection during the past 14 days:过去14日内至今，所在办公室/家庭等是否出现2人及以上有发热和/或呼吸道症状：No 否 Have you had the following symptoms during the past 14 days:请选择过去14日内至今，是否有以下症状：Yes 是 Have you had the following symptoms during the past 14 days:请选择过去14日内至今，是否有以下症状：No 否 If yes, please tick your symptoms with“√”:如有，请勾选：Fever发热 If yes, please tick your symptoms with“√”:如有，请勾选：Chills寒战 If yes, please tick your symptoms with“√”:如有，请勾选：Fatigue乏力 If yes, please tick your symptoms with“√”:如有，请勾选：Cough咳嗽 If yes, please tick your symptoms with“√”:如有，请勾选：Difficulty breathing呼吸困难 If yes, please tick your symptoms with“√”:如有，请勾选：running nose鼻塞流涕 If yes, please tick your symptoms with“√”:如有，请勾选：Headache头痛 If yes, please tick your symptoms with“√”:如有，请勾选：Sore throat咽痛 If yes, please tick your symptoms with“√”:如有，请勾选：Chest pain胸痛 If yes, please tick your symptoms with“√”:如有，请勾选：Muscle pain or joint pain肌肉或关节痛 If yes, please tick your symptoms with“√”:如有，请勾选：Nausea and vomiting恶心呕吐 If yes, please tick your symptoms with“√”:如有，请勾选：Diarrhea腹泻 If yes, please tick your symptoms with“√”:如有，请勾选：Others其它不适症状 Have you taken any medications for fever, cold or cough during the past 14 days:过去14日内至今，是否曾服用退烧药、感冒药、止咳药：Yes 是 Have you taken any medications for fever, cold or cough during the past 14 days:过去14日内至今，是否曾服用退烧药、感冒药、止咳药：No 否 Have you tested for COVID-19 during the past 14 days:过去14日内至今，您是否接受过新型冠状病毒检测：Yes 是 Have you tested for COVID-19 during the past 14 days:过去14日内至今，您是否接受过新型冠状病毒检测：No 否 If yes, is the result positive:如果您曾接受过新型冠状病毒检测，检测结果是否为阳性：Yes 是 If yes, is the result positive:如果您曾接受过新型冠状病毒检测，检测结果是否为阳性：No 否 Have you been infected with COVID-19?:您是否曾患过新冠肺炎？：Yes 是 Have you been infected with COVID-19?:您是否曾患过新冠肺炎？：No 否 If yes, have you tested positve for COVID-19 after recovery?:如是，治愈后是否出现过核酸检测结果阳性：Yes 是 If yes, have you tested positve for COVID-19 after recovery?:如是，治愈后是否出现过核酸检测结果阳性：No 否 Have you been injected with COVID-19 vaccine:您是否接种过新型冠状病毒疫苗：Yes 是 Have you been injected with COVID-19 vaccine:您是否接种过新型冠状病毒疫苗：No 否