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Patient Name: D.O.B. Today's Date: Date of Injury: Concussion/Head Trauma Symptoms 0 None 6 Severe (Symptoms as of Today) Headache0123456Pressure0123456Neck Pain0123456Balance Problems/ Dizziness0123456Nausea/Vomiting0123456Vision
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Today's date is November 2, 2021.
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