CH035
| Date of Injury |
| Yesterday |
| Age |
| 38 |
| Profession |
| Unemployed |
| Circumstances |
| Jumped off a table |
| P.M.H. |
| Nil |
| D.H. |
| Nil |
| Notes |
| Generally well, active; smokes 30/day, alcohol 4 pints/day |
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