JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
肺結核七分篩檢表(自我檢測表) 107/10/05截止填寫
請依自己身體現在的情況詳細填寫~~衛保組關心您!!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
班級代號
*
Your answer
學號
*
Your answer
性別
*
女
男
咳嗽兩週
*
2 points
小於兩週
大於兩週
咳嗽有痰
*
2 points
沒有痰
有痰
胸痛
*
1 point
無胸痛
有胸痛
沒有食慾
*
1 point
無此症狀
有此症狀
Required
過去三個月內體重減輕
*
1 point
無體重減輕
有體重減輕現象
當上述症狀達5分以上，建議趕快就醫檢查，以即早診斷及接受治療。
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
