Tờ khai y tế/Vietnam Health Declaration

Chọn ngôn ngữ để khai báo y tế /Select the language to declare health:
MEDICAL DECLARATION FORM
This is important document, your information is vital to allow health authorities contact you to prevent communicable diseases
Warning: Declaring false information is a violation of Vietnamese law and may be subject to criminal handling

Travel information (*)

Contact information in VietNam

Phone number you will use in Vietnam (Is Roaming number or Vietnam number)

If you have any of the followings at present or during the past 21 days (until the date of entry/exit/transit)? (*)
Symptoms Yes No
Fever (*)
Cough (*)
Difficulty of breathing (*)
Sore throat (*)
Symptoms Yes No
Vomiting (*)
Diarrhea (*)
Skin haemorrhage (*)
Rash (*)
History of exposure: During the last 21 days, did you (*)
Yes No
Visit any poultry farm / living animal market / slaughter house / contact to animal (*)
Care for a sick person of communicables diseases (*)
Check test results

Test

Change the CAPTCHA code
The data you provide is completely confidential and only serves for the prevention of epidemics, under the management of the Vietnam National Steering Committee for COVID-19 Epidemic Prevention and Control. When you press "Submit", you understand and agree with the above statement.
Tải App Vietnam Health Declaration trên