Khai báo

MEDICAL REPORT

Warning: Declaring false information is a violation of Vietnamese law and may result in criminal prosecution.

If you have made a declare please: Redeclare

Thông tin người khai hộ, họ và tên:

Notify the driver/person on the vehicle transporting goods into the city

Foreigners declare to enter Da Nang

Full name*:

Gender*:

Male Female

Nationality*:

Your phone number*:

Passport Number/ID Card*:

Date of birth*:

Health insurance card number:

Email:

Residence*:

Where were you in the past 14 days ?:

Do you go (depart) from or go through these places?

In the past 14 days, have you experienced at least 1 of the following symptoms: fever, cough, shortness of breath, pneumonia, pain, fatigue??

	Yes	No
Patients with or suspected of having COVID-19*
People from countries with COVID-19*
Symptoms (fever, cough, difficulty breathing, sore throat)*

In the past 14 days have you had symptoms such as cough, fever, sore throat, fatigue, pneumonia, loss of taste and smell?* No Yes

Residence in isolation zone* No Yes

You are a Danang citizen
You reside in Da Nang and are returning from another location
Passing through Da Nang

Departure place*:

Where to stop and stay when coming to Da Nang*:

Please specify your accommodation address*:

Organizations and individuals come to contact to work in Da Nang*:

Destination contact phone*:

Media type*:

Travel Information*:

Driver's phone number*:

On the vehicle being carried (number of people, what goods)*:

Date and time in Da Nang*:

Date and time of leaving Da Nang*:

Upload personal photos (face photo, no mask) for face recognition through quarantine

Tải ảnh lên

Please enter the security code*:

* Hotline support: (0236) 1022 * Electronic declarations can replace paper slip declarations * The data you provide is completely confidential and is for epidemic prevention only

Please enter the security code*: