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Rovince AB Time of Accident: Was the Accident Reported to the Police? Date Reported: (DD-MM-YYYY) Yes No Brief description of how the accident occurred and how you were injured AB-1 (2004/10) Page 1 of 5 Section 2: Summary of Injury, Diagnosis and Treatment (This section is to be completed by a Primary Health Care Practitioner (Chiropractor, Physical Therapist or Medical Doctor) or by a Dentist) Part 4 Name of Primary Health Care Practitioner or Dentist Information of.

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