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SATUSEHAT Health Pass (SSHP) Form
Full name
Mobile number
IDN$62$Indonesia
Passport number
Date of arrival
Port of arrival
Select port of arrival
Do you have any of the following symptoms: fever, swollen lymph nodes, or skin lesions / rashes?
Yes
No
Have you had close contact with a person showing symptoms of mpox or with animals such as rodents or primates in the 21 days prior to your arrival in Indonesia?
Yes
No
Countries of origin departure, transit and others that you visited within 21 days before departure to Indonesia (Can select more than one)
Select country(s)
Please recheck your declaration and ensure all information is correct before submitting
Captcha
I declare that all the information above is correct
Submit