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Case Summary
Report Number: 2011-1234
FROL ID: 1003689
Carrier Claim Number: 1234.5678-90
User Defined Employee ID: 222222222

Alex Crystal SSN: 111-22-3333 Ph: (222)333-2345
EmployeeAddress1 EmployeeCity NC 77777-8888
Injury Information
Date Injured: 02/22/2012
Part of Body: Not Defined (right side)
Physician Information
Dr. Detroit
Hospital Information
Planetary Medical (845)345-3458
1131 Planet Street Orbit, TX 45688-8383


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10795    Sample User  03/13/2012Build Link
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10790    Sample User  03/13/2012Build Link
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