| Contact Information | |
|---|---|
| First Name | jennie |
| Last Name | jackson |
| Address | 314 mountain rd |
| City | Cornwall-on-hudson |
| State | NY |
| Province | |
| Zip/Postal Code | 12520 |
| Country | United States |
| Home Phone | 845 - 534-2933 |
| Work Phone | - |
| Fax | |
| jennie-brad@hvc.rr.com | |
| Alternate Email | |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Child |
| Name of Injured | Douglas Jackson - |
| Date of Injury | 04/02/04 |
| Type of Injury | Obstetric |