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General health declaration

General health declaration

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Instruction for medical declarationMedical declaration form

Warning: Any false statement in the declaration is a violation of Vietnamese laws and may result in criminal prosecution.

In the past 14 days, which province / city / territory / country have you travelled to? *

In the past 14 days, have you experienced at least 1 of the following symptoms: fever, cough, shortness of breath, pneumonia, sore throat, fatigue, loss of taste? *

In the past 14 days, have you been in contact with: *

Yes
No
Confirmed/Suspected Covid-19 case(s)
People from countries with Covid-19
People with symptoms of fever, cough, shortness of breath, pneumonia

The data you provide is kept completely confidential and only will serve pandemic prevention and control purposes, under the management of the National Steering Committee for COVID-19 Prevention and Control. Pressing the "Submit" button means you understand and agree.