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CONFIDENTIAL
Page 1 of 6
UR NUMBER
SURNAME
GIVEN NAME(S)
DATE OF BIRTH
AFFIX PATIENT LABEL HERE
LeftRight
Date / / Time : Signature of assessing doctor
Victorian Forensic Paediatric
Medical Service
Body chart child
*FRC950470*
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I don’t pay good wages because I have a lot of money; I have a lot of money because I pay good wages. | Robert Bosch