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Please give the following details about each accident starting with the earliest:
Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, POISON, etc) | Part or Parts injured | Age when injured (in years and months) | Treatment, Hosp, I.P., Hosp. O.P., Nursing Home Own Home | If treated in own home, who gave treatment (Doctor, Nurse, other) | Details of any remaining scarring, disability or deformity | |
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First Accident 1 | ||||||
Second 2 |
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