NN011
| Date of Injury |
| Yesterday |
| Age |
| 57 |
| Profession |
| Factory worker |
| Circumstances |
| Fell down a dip in the ground |
| P.M.H. |
| NAD |
| D.H. |
| Nil |
| Notes |
| Non-smoker, no alcohol, UCLA Activity Score 6 (regularly participates in moderate activities such as swimming and can do unlimited housework and shopping) |
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