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["企业湖北或到过湖北人员信息登记表"]
["               单位(盖章):                                         报表时间：2020年2月3日  "]
["序号","姓名","性别","年龄","身份证号码","联系方式","现所在地","到湖北时间","是否去过华南海鲜城等农贸市场","是否食用接触野生动物","体温","有无发热（请填是/否）","有无乏力、干咳等不适症状","计划反穗时间","备注"]
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["填报人：                                                          联系方式： "]
[" "," "]

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