ࡱ>  RYbjbj8 HH8@5t(PPP_4a4a4a4a4a4a4$ 79B4uP."PPP4HH4p*p*p*P| H8_4p*P_4p*p*:/, 0QRk"/ K450@5/R:%J: 0: 0@PPp*PPPPP44&(JPPP@5PPPP:PPPPPPPPP : eP^hgf^hgyvhNh ITEMS REQUIRED FOR HEALTH CERTIFICATE Form C (S(u)(for Reference Only)hgeg ____/____/____ (t^) (g) (e) Date of Examination ____/____/____ (-) ($) (9) W ,g D e ( BASIC DATA)  [00[0h0g (LABORATORY EXAMINATIONS) A. uS_Vu(Θu)KNbSO3'`hbJTb2cyfProof of Positive Measles and Rubella Antibody Titers or Measles and Rubella Immunization Certificates  a.bSOhgAntibody Tests ubSOMeasles antibody titers %3'` Positive %4'` Negative %*gnx[Equivocal _Vu(Θu)bSORubella antibody titers %3'` Positive %4'` Negative %*gnx[Equivocal b.2cyf Vaccination Certificate (+Tuׂ Ty0cyeg0cyUSMOb;S^~{z0YhD|^ecy~U_ vQcyt^_{'YN1\YhDяgcy~U_ cyegNQVeg\v2hTN N0) (The certificate should include the date of vaccination, and the name of the hospital or clinic administering the vaccine or the signature of the physician administering the vaccine. If the childhood immunization record is submitted, it is important to include the record of the vaccination administered at least one year of age. In addition, if the recent immunization record is submitted, it is important to note that the date of vaccination should be at least two weeks prior to traveling abroad.) %u2cyfMeasles Immunization Certificates %_Vu(Θu)2cyfRubella Immunization Certificates c. %~;S^ċ0O gcyy_ f N[cy0(Having contraindications, not suitable for vaccination) B. XIQhg~8hChest8-Ray for Tuberculosis  eg~8huؚΘi0W:SN\PYu3*NgN N{RZPdkhg(Those who arrived from areas at high risk for tuberculosis and have plans to stay in Taiwan for more than three months should undergo chest 8-ray examination.) XIQSs(X-ray Findings) $R[(Results) %T*CJPJaJ'h{h{CJPJQJaJnHo(tH h{h{CJPJaJnHtHhYgh3Q5CJPJaJo('h{h{5CJPJQJaJnHtH"hYghsp5CJPJQJaJo(#h{h{5CJPJaJnHtH*h{h{5CJPJQJaJnHo(tH>@LhjpܙeN9)h{h{B*CJPJaJnHphtH-h{h{B*CJPJ_HaJnHphtH4h{h{B*CJPJQJ_HaJnHo(phtH0h{h{B*CJPJQJaJnHo(phtH1h{h{B*CJOJPJQJaJnHphtH%h{h{B*CJPJnHphtH-h{h{B*CJOJPJQJnHphtHhw-*h3QB*CJph,h{h{B*CJPJQJnHo(phtH&(4pԽԑl[l[I[l[;hw-*h3QCJPJaJo(#h{h{CJPJ\aJnHtH h{h{CJPJaJnHtH'h{h{CJPJQJaJnHo(tH!hw-*h3QB*CJPJaJph0h{h{B*CJPJQJaJnHo(phtH$hTh3QB*OJPJQJo(ph,hw-*h3QB*CJOJPJQJaJo(ph)h{h{B*CJPJaJnHphtH,h{h{B*CJPJ\aJnHphtHvj d$Ifgd3Qjkd$IfK$L$TX o&j&064 aytgT2d$IfVDWD]2^`gd(K$`<#$ & F z6dUD3VDWD ]z^6`a$gdw-*%$ & F z6dG$UD3VDWD ]z^6`a$gdw-*6dG$VDWD ^6`gdw-*ekd$$If2L%&0&64 ahyt=[,.óhQQ>$hw-*h3Q5B*CJPJaJph,h{h{5B*CJPJaJnHphtH/h{h{5>*B*CJPJaJnHphtH3h{h{5B*CJPJQJaJnHo(phtH0h{h{B*CJPJQJaJnHo(phtHhw-*h3QCJKHPJaJo(#h{h{CJPJ\aJnHtH'h{h{CJPJQJaJnHo(tH+h{h{CJKHPJQJaJnHo(tH .\ 4$d$$Ifa$gd= d$$Ifgd=8dG$VDWD ^8`gd{8dVDWD ^8`gd{"$6dHG$UDdVDWD XD]^6`a$gdw-*.04>@FLNZ\jl NP˴˴ˡ˴u`J*jh0h3QB*CJPJUaJph)h{h{B*CJPJaJnHphtH'hw-*h3Q5>*B*CJPJaJph/h{h{5>*B*CJPJaJnHphtH$hw-*h3Q5B*CJPJaJph,h{h{5B*CJPJaJnHphtH3h{h{5B*CJPJQJaJnHo(phtH4h{h{5B*CJOJPJQJaJnHphtH 0246nvxHH"HomU(hTh3QB*CJOJPJQJo(ph%hTh3QB*CJOJPJQJph)h{h{B*CJPJaJnHphtH0h{h{B*CJPJQJaJnHo(phtH*jh0h3QB*CJPJUaJph%h0h3QB*CJPJQJaJph!h0h3QB*CJPJaJph*46prtv|m||$d$$Ifa$gd= d$$Ifgd=vkd$$If4\@ D%\   `%4 af4yt Kvxz|~|m||$d$$Ifa$gd= d$$Ifgd=vkde$$If4\@ D%\   `%4 af4yt K|m||$d$$Ifa$gd= d$$Ifgd=vkd$$If4\@ D%\   `%4 af4yt KHH H"H|m||$d$$Ifa$gd= d$$Ifgd=vkd$$If4\@ D%\   `%4 af4yt K Physician ) eq \o\ad(bN=|z,000000000000)Name  Signature ( Superintendent )egDate  / / ,gf N*NgQ gHeValid for Three Months DU_~8huؚSusV[b0W:S Appendix: Countries or areas at high risk for tuberculosis 'k2m EuropeRomaniaWl<\N0Bosnia and Herzegovinale<\NNk^XT~~0N2m0 N(+TeςT) Asia, West Asia Afghanistan?[Wl0Angola[Tb0ArmeniaN<\N0AzerbaijanN^Xb6q0Bangladesh_[RbV0Belarus}vOWe0Bhutan N9N0Brunei Darussalame0CambodiagW[0China'YF0W:S0CongoRg0East Timor (Timor-Leste)N^vl0GeorgiaTNlN0Hong Kong /n0IndiapS^0IndonesiapS^<\N0Iraq ObKQ0KazakhstanT(KQ0Kyrgyzstan T\ Te0Lao People s Democratic Republic[V0Latviab1~N0Lithuaniazv[0Macauo0MalaysialegN0MongoliaS0Myanmar8u0Nepal<\l\0North KoreaS0Pakistan]WefW0Papua New Guinea]^N~QQN0Philippines_[0South KoreaWS0RussianOWe0Sri LankaȇpQaS0TajikistanTX TKQ0ThailandlV0TurkmenistanW^f0UkraineLNKQpQ0UzbekistanLNyQ+RKQ0VietnamWS0Yemen_N0*Ys^ m PacificGuamsQ\0KiribatiW̑]e0Marshall Islandsl~\\0Micronesia[KQW<\N0Niue~W0Northern Mariana IslandsSl̑N~\0Palau^ t0TuvaluTt0VanuatuN^0^2m AfricaAlgeria?\S)RN0BeninWS0Botswanal-g0^ T~l"}0Burundifm0W0CameroonU0Cape Verde ~_҉\0-N^qQTVCentral African Republic0Chadg_0CongoRg0Cote d Ivoire (Ivory Coast)yyrt0Djibouti T^c0Equatorial GuineadSQQN0EritreaS)RWN0Ethiopiac"}kN0GabonRm_0Gambia QkN0Ghana揳~0GuineaQQN0Guinea-BissauQQNk~0KenyaN0LesothoV"}Xb0LiberiaVk^tN0MadagascarlReR0MalawilbZ0Malil)R0Mauritaniak̑TX<\N0MoroccoidmT0MozambiqueQhkKQ0Namibia~s|kN0Niger<\e0NigeriaHYS)RN0RwandabS[0Sao Tome and Principle #WYnfgN0Senegal^XQR\0Sierra LeonerP[q\0Somalia"}l)RN0South AfricaWS^0Sudanς9N0SwazilandStNmpQ0TanzaniafW\<\N0TogoYT0UgandaLNr^0Zambia^kN0Zimbabwe%m]^02m AmericaBolivias)R~N0Brazil]0Dominican RepublicYs|<\R0EcuadorStY\0El Salvador(\tY0GuatemalaqS0Wlb0GuyanavN0Haitiwm0W0Honduras[be0Nicaragua<\Rbt0Panama]bl0Paraguay]b-W0Peruy0Surinameς)RWS0l~8huؚSus0W:S|c~8huSusؚNkASNNS40Nv0W:S0 NoteCountries or areas at high risk for tuberculosis refer to countries or areas with a tuberculosis incidence rate that is higher than 40 per 100,000 population.     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