East Care

ACC45 Injury Claim

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Accident Details

Personal details are pre-populated from the Casual Form or from the existing patient record.

The date the accident occurred.

* Did the accident occur in New Zealand?
* Did the accident happen at work?
* Which part of your body is injured?
HeadFaceNeckChestAbdomenPelvisLeft ShoulderLeft Upper ArmLeft ElbowLeft ForearmLeft HandLeft HipLeft ThighLeft KneeLeft Lower LegLeft FootRight ShoulderRight Upper ArmRight ElbowRight ForearmRight HandRight HipRight ThighRight KneeRight Lower LegRight Foot

Left and right are your own left and right.

Tap the diagram to select. Tap again to deselect. You can select more than one.

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