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Physical Examination Level of Conciousness Muscle Power Listening Speaking Alert Confuse Drowsy Unconcious Right Grade I II III IV V Arm Left Understanding Difficult in Understanding Can t understand normal Dysarthria Activity aily Life Decision Making Leg Working Temporary Total Disabled Permanent Patial Disable Permanent Total Diaabled Type of Disabled Prognosis Additional Comment Name of Physician Signature Thailand s Medical Registration No. Qualification Specialty...
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