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Health Declaration Form
First Name
Last Name
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I am not experiencing the symptoms: fever, cough, sore throat
Name of Restaurant
Date Today
Seating/Table No./Location
I hereby authorize this establishment to collect and process the data indicated herein for the purpose of contact tracing effecting control of the COVID-19 transmission. I understand that my personal information is protected by RA 10173 or the Data Privacy Act of 2012 and that this form will be destroyed after 30 days from the date of accomplishment, following the National Archives of the Philippines protocol.
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