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["学生健康监测（因病缺勤、晨检）报表      日期："]
["学院/班级","姓名","性别","宿舍","联系电话","缺勤日期",null,"缺勤原因",null,null,"如未确诊，填写是否存在以下症状",{"$nulls":5},"备注"]
[{"$nulls":5},"起","止","疾病名称",null,null,"发热（0C）","皮疹","腹泻","黄疸","眼结膜充血","其它（注4）"]
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["注：依据《传染病防治法》须报告的传染病：\n（1）甲类传染病：鼠疫、霍乱。\n（2）乙类传染病：传染性非典型肺炎、艾滋病、病毒性肝炎、脊髓灰质炎、人感染高致病性禽流感、麻疹、流行性出血热、狂犬病、流行性乙型脑炎、登革热、炭疽、细菌性和阿米巴性痢疾、肺结核、伤寒和副伤寒、流行性脑脊髓膜炎、百日咳、白喉、新生儿破伤风、猩红热、布鲁氏菌病、淋病、梅毒、钩端螺旋体病、血吸虫病、疟疾。\n（3）丙类传染病：流行性感冒、流行性腮腺炎、风疹、急性出血性结膜炎、麻风病、流行性和地方性斑疹伤寒、黑热病、包虫病、丝虫病，除霍乱、细菌性和阿米巴性痢疾、伤寒和副伤寒以外的感染性腹泻病。\n（4）其它包括症状：a.胸痛 b.痰带血丝 c.咯血 d.咳嗽2周以上 e.头痛 f.肌肉酸痛"]
[]
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[{"$nulls":15},"辅导员签名："]

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