| Contact Information | |
|---|---|
| First Name | Carmen |
| Last Name | Smith |
| Address | 2 Orllwyn Terrace |
| Penrhiwllan | |
| City | Cardigan |
| State | |
| Province | |
| Zip/Postal Code | SA44 tNG |
| Country | United Kingdom |
| Home Phone | - |
| Work Phone | - |
| Fax | |
| carmen.smith@micropharm.co.uk | |
| Alternate Email | |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Child |
| Name of Injured | Kelly - Harcourt |
| Date of Injury | 04/11/2013 |
| Type of Injury | Traumatic |