ABC Auto Insurance PO Box 111 Suisun City, CA 11111-0111 Patient: LAST, FIRST Claim Number: 00-12345-6 D.O.B.: 01/01/1940 Date of Injury: 03/28/2006 CHIROPRACTIC MEDICAL-LEGAL REPORT Dear Mr. Adjustor, This report is submitted as the final report regarding injuries sustained by First.