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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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People don’t believe what you tell them. They rarely believe what you show them. They often believe what their friends tell them. They always believe what they tell themselves. | Seth Godin