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["因病缺勤（课）病因追查登记表"]
["院部名称：XXXX学院",{"$nulls":8},"20 年  月  日---20 年  月  日"]
[]
["姓名","年级  班级","因病\n缺课日期","主要症状","是否经\n医院诊断","就诊医疗机构","诊断\n疾病名称","就诊日期","返校日期","宿舍号","联系电话\n（手机）","是否向\n校医院报告","备注"]
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["注：1、是否向校医院报告指依据症状可疑或已经其他医院诊断为传染病者，应当及时向校医院报告（校医院接报电话：13965533329)；2、该登记表(纸质)一式两份，一份由各学院存档备查，一份每半月汇总加盖本院公章后交至校医院预防保健办公室。"]

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