ࡱ> 685g bjbj:: ."Xv\Xv\ {^^8"$F$jj4RRRSUUUUUU$!$`yR00"RRyhhhRShRShhGPJ 45_?0g,$$$RRhRRRRRyyRRRRRRR$RRRRRRRRR^> : Letterhead Contact numbers phone / fax / email Code for report (includes Drs and typist initials) Date (report typed) Interim Medical Report prepared for Title, Name Organisation Address RE Name: full name and also-known-as names. Date of birth Hospital unit record number Author of report Brief details only Full name, employed by (employer) in the position of (job title) I assessed (name) on (date) at (location) Reason for Medical Assessment Brief chronology (potted story) (name) was admitted to (hospital) on (date) because (presenting story, symptoms and signs) He/she was subsequently found to have (results of examination and investigations list as dot points) Medical Investigations to date have identified Definite findings Possible findings Relevant negatives (summary only) Results of . tests are not yet available Limitations to opinion At this time, the forensic evaluation of injury and medical assessment of risk of harm has not been completed. The forensic opinion provided below is subject to change as additional information becomes available. It should be noted that this opinion may be subject to highly significant change depending on the results of tests, additional examination and information yet to be collected. OPINION Significant concerns have arisen to suggest that (name) (has/may have) experienced injury as a result of non-accidental trauma. Medical investigations are underway to determine if there is an alternative explanation and/or medical cause to account for his/her examination findings and results of investigations. It currently seems ^^^^^ likely that **** Signature Name and date signed Phrases you might like to choose (suggestions only) ^^^^^ Almost certainly Highly likely .. probable Likely Has not been determined Unlikely Highly unlikely Almost certainly not Was caused by Is the result of at least some of his/her examination findings have been caused by assault. his/ her .., (finding/injury) is the result of non-accidental trauma has been caused by a combination of trauma and preexisting medical condition has been caused by accidental trauma Additional factors to consider include has not been determined is not yet known information about has not been provided     Forensic INTERIM Medical Report for Court Template  PAGE  PAGE 2  DATE \@ "M/d/yyyy" 7/8/2019 {| - 1 ? 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