3
Shared Docs
3
Same-Page
3 / 3
Mentions
tim for injuries related First Hospital Other Hospital First Doctor (riot on hospta0 Other Doctor First Dentist Victim s Counselor Full Name Complete Address rnfvtc f.-r(1-‘c sectfon10.)77t* ge-c- A0V-n+ VI S EACri to this crime: Phone X 10 Tell us about the victim's dependents or o depended on the
victim receive any medical treatment? 0 Yes J (If No, skip to Tell us about the health professionals who treated the victim for injuries related First Hospital Other Hospital First Doctor (riot on hospta0 Other Doctor First Dentist Victim s Counselor Full Name Complete Address rnfvtc f.-r(1-‘c sect
Yes K No (If No, skip to section10.) Tell us about the health professionals who treated the victim for injuries related to this crime: Full Name Complete Address Phone First Hospital Other Hospital First Doctor (not in hospital) Other Doctor First Dentist Victim's Counselor 10 Tell us about the victi
o section10.) Tell us about the health professionals who treated the victim for injuries related to this crime: Full Name Complete Address Phone First Hospital Other Hospital First Doctor (not in hospital) Other Doctor First Dentist Victim's Counselor 10 Tell us about the victim's dependents or other
O Yes O No (If No, skip to sectIon10.) Tell us about the health professionals who treated the victim for Injuries related to this crime: Full Name Complete Address First Hospital Other Hospital First Doctor (not in hospital) Other Doctor First Dentist Victim's Counselor Phone It ) ( ) ) 10 Tell u
skip to sectIon10.) Tell us about the health professionals who treated the victim for Injuries related to this crime: Full Name Complete Address First Hospital Other Hospital First Doctor (not in hospital) Other Doctor First Dentist Victim's Counselor Phone It ) ( ) ) 10 Tell us about the vict
Entities connected to both Complete Address and First Hospital

Medicaid
ORGANIZATIONVictim Services
ORGANIZATIONHIPAA
ORGANIZATIONNew York State Law
ORGANIZATIONthe New York State Department of Health'
ORGANIZATIONthe Social Security Death Benefit
ORGANIZATIONPrimary Insurance Company
ORGANIZATIONSee the Court Ordered Restitution Information
ORGANIZATIONGovernmental Agency Name
ORGANIZATIONThe New York State Public Health Law
ORGANIZATIONS. Swan
ORGANIZATIONOVictim Assistance Program
ORGANIZATIONDisability Insurance
ORGANIZATIONthe State of New York
LOCATIONthe New York City Commission of Human Rights
ORGANIZATIONthe Death Certificate
ORGANIZATIONSocial Security Benefits
ORGANIZATION