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Get Mn Serious Injury Report 2020-2024

S://mn.gov/omhdd Serious Injury Report Date of report: (If all information is not available within 24 hours, please submit the report with the information you have.) CLIENT INFORMATION First Name: MI: Last Name: Client Facility Name (if applicable): Gender: Female Other Male Date of Birth: Ethnicity: African African American American Indian or Native Alaskan Asian Caucasian or White Choose Not to Respond Hispanic or Latino Other Pacific Islander or Native Hawaiian County of Res.

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