| Name | Description | Type | Additional information |
|---|---|---|---|
| Name | string |
None. |
|
| Gender | string |
None. |
|
| DateOfBirth | string |
None. |
|
| HomeAddress | string |
None. |
|
| City | string |
None. |
|
| State | string |
None. |
|
| Zip | string |
None. |
|
| PhoneNumber | string |
None. |
|
| Whatwaspersondoingbeforeincident? | string |
None. |
|
| Wasindividualinjuredintheincident? | string |
None. |
|
| DidInjuryresultinaFatality? | string |
None. |
|
| ResultofIncident | string |
None. |
|
| CauseofIncident | string |
None. |
|
| InjuredBodyPart | string |
None. |
|
| Pleasedescribepersonsinjury | string |
None. |
|
| Waspersonconsideredminor? | string |
None. |
|
| Pleaseprovideparentsname | string |
None. |
|
| Pleaseprovideparentsphonenumber | string |
None. |
|
| Takenfromsceneviaambulance | string |
None. |
|
| Whatshoeswasclaimantwearing? | string |
None. |
|
| Wasclaimantstruckbyobject? | string |
None. |
|
| Ifstruckbyobjectwhatobject? | string |
None. |
|
| Didthepersonrefusetreatment? | string |
None. |
|
| IfYesexplainwhy? | string |
None. |
|
| Wastreatmentprovided? | string |
None. |
|
| DidthepersonsignthemedicalreleaseformIfyespleaseattach? | string |
None. |
|
| WereEmergencyServicescalled? | string |
None. |