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Position in Vehicle
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Impact sustained to:
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Office location
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Date of the Accident:
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History of Present Illness:
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Medical History
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Medical History
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Past Medical History Freewrite
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Past Surgical History
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Comments
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Medications
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Allergies
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Social History
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Marital Status
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Employment Status
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Comments
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Alcohol
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Comments
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Smoking
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History of previous MVA
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Diagnostic Test Results
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